The Scottish Government

2. UK figure.

Closing the Opportunity Gap/Promoting Equality

Closing the opportunity gap

• A high level Closing the Opportunity Gap objective for health was announced in July 2004: to increase the rate of improvement of the health status of people living in the most deprived communities, in order to improve their quality of life, including their employability prospects.

• Supporting this Closing the Opportunity objective, a specific health inequalities target was agreed as one of the Health and Community Care targets for SR2004: to reduce health inequalities by increasing the rate of improvement across a range of indicators for the most deprived communities by 15% by 2008. Six key indicators have been selected:

• under 75 CHD mortality;

• under 75 cancer mortality;

• adults smoking;

• smoking during pregnancy;

• teenage pregnancy (aged 13 - 15); and

• suicides in young people (aged 10- 24).

These targets are ambitious and stretching given that recent evidence points to an increasing health inequalities gap between most and least affluent, and will require concerted and effective action at local and national level.

• We are currently developing the next phase of health improvement work. This work takes forward the recommendations in the Kerr report: that we identify people at risk in deprived communities and actively recruit them into interventions programmes and follow them to ensure progress is effective. Such a programme, which would deliver effective health interventions through primary care services and the new Community Health Partnerships, will reduce deaths and hospital admissions from conditions such as stroke and CHD. We are also developing a healthy weight strategy to tackle the rising obesity epidemic, and developing a framework for local health improvement actions by community planning partners.

• Smoking, poor diet, poor mental health, high levels of alcohol consumption and low rates of physical activity are all major contributory factors to chronic ill health and the major causes of morbidity and mortality. National guidelines and programmes will support local partnerships to have a particular focus on positive outcomes around these factors. Action plans on each of these areas have already been published by the Executive and a ban on smoking in public places will come into force in spring 2006. In addition to driving forward implementation of smoke-free areas legislation, efforts will be stepped up to reduce the number of smokers in the general population and to close the gap in smoking prevalence between the poorest and the most affluent groups.

• We will devote specific resources as follows:

• £1m per annum over five years from 2004-05 for the Glasgow Centre for Population Health;

• £15m in 2005-06 for Unmet Needs Pilot Studies to provide good evidence of interventions which increase uptake of health services by deprived populations;

• £9m for 2005-08 for Phase 2 of the three National Health Demonstration Projects and associated Learning Networks, all with a clear focus on tackling health inequalities;

• £4m in 2004-06 for Well Man Pilots with a focus on deprived communities; and

• £3.2m in 2004-06 for local suicide prevention work.

• £2m in 2004-06 for piloting Personal Health Plans

• £6m between 2006-08 for implementation of smoke-free legislation

• £20m between 2006-08 for smoking cessation activity

• Health improvement activity is funded through a range of SEHD and Executive programmes, many of which will impact both directly and indirectly on tackling health inequalities.

Promoting equality

• In addition to traditional health improvement activity, NHSScotland also recognises that employment is a key contributor to good health. This factor coupled with a genuine recruitment need has led a number of NHSScotland employers, with the support of SEHD, to develop structured routes to employment for economically inactive citizens. Current schemes target claimants of Incapacity Benefit, Income Support, Jobseekers allowance and people with refugee status, but are open to any one who is not working or is in low paid/low skilled work. The courses are designed to enable participants to compete for vacancies on a level playing field. The Minister for Health and Community Care has committed to ensuring that NHSScotland employers are able to offer at least 1,000 pre-employment opportunities between 2004 & 2006. Remaining NHS Boards will be offered support by SEHD and will be encouraged to develop courses appropriate to their local circumstances to ensure that equality of employment opportunity exists.

• Closing the Opportunity Gap also means that the NHS needs to respond effectively to the individual circumstances of people's lives - including age, gender, ethnicity, disability, religion, sexual orientation, mental health, economic, location or other circumstance - so that all individuals are treated in a fair and sensitive way, and can access the right health services for their needs. This is central to our commitment to social justice and the need to bridge the opportunity gap for all.

• The Fair for All approach was initially developed to ensure that the needs of ethnic minorities and refugees were effectively met. We are committed to ensuring an effective approach across the NHS to delivering all of the equality strands, including race, disability, gender and sexual orientation, to ensure that health services respond sensitively to individual needs. The NHS Reform (Scotland) Act 2004 now underpins this commitment by placing a specific duty on NHS Boards to promote equality of opportunity.

• We will raise awareness of equality and diversity issues in the workplace and promote accessible recruitment methods. This will allow us to offer improved equality of employment opportunity. Attracting a wider pool of talent for NHS vacancies and improving retention rates will help us ensure that the workforce reflects the local community which in turn assists in the delivery of a culturally sensitive service which is responsive to the needs of the public and our patients.

• By 2008 we will increase the number of older people receiving intensive home care to 30% of all people receiving long term care.

• Our National Health: A Plan for Action, a Plan for Change describes how "we will achieve over time, our core aims of building a national effort to improve health, reduce inequalities in health and make the NHS a national health service not a national illness service". This is an integral part of sustainable development. To help develop a sustainable workforce the Health Portfolio is encouraging men to take a greater interest in their own health by providing support services including the development of well man clinics.

• Initial analysis of the data identified in the pilot on smoking prevention and cessation underlines a marked difference in the response of girls and boys. Since 2000, the number of 15 year old boys smoking has remained significantly lower, at around 15%, than that of girls at around 24%. Our commitment to equality will be enhanced by utilising information from the pilots to identify gender differences and inform resource allocation. In addition, by making the link between objectives like smoking prevention and cessation and increasing participation in sport, we will be better able to link policy priorities, resource allocation and implementation strategies.

Sustainable Development

• NHSScotland has a target for 2% per annum reduction in climatically adjusted energy consumption over the 9 year period 2001-2010. The NHSScotland Property and Environment Forum are introducing web-based environment data gathering software which will facilitate the benchmarking of water and effluent consumption. Indications are that savings of up to £3m may be achievable if benchmark consumption levels met.

• Our commitment to developing Scotland as a health improving environment through the Health Improvement Challenge complements and can add value to sustainable development. These agendas combine to deliver shared goals such as providing opportunities for walking and cycling and influencing food distribution and food provision outcomes. The NHS has a major role to play as an exemplary manager of its estates, contracts and staff, to be a force for change for a significant proportion of the population.

• Ensure that NHS Estates Policy addresses access to services that also promote walking and cycling including building planning as well as outdoor space planning

• Building on learning from experience in food provision in schools, introduction of standards for food in the NHS supported by specifications for food purchased and procured in the public sector.

• Development of NHS procurement to allow opportunities for provision of fresh local food.

• Development of the NHS as a health promoting workplace and NHS outlets as health promoting environments

• Outside the NHS, we will continue to co-ordinate and lead work across Government and delivery sectors to improve food and health, and opportunities for people to be physically active as part of normal daily life. Led by Cross-Government Ministerial Councils for Food and Health and Physical Activity. Environment and Transport Departments are involved to ensure health benefits are integrated into transport and environment policy and vice versa

• Continue productive joint working between the health and education sectors to support the further development of health promoting schools through action to further develop whole school approaches to food and physical activity and to promote emotional well-being and good mental health.

• Continue to work with NHS Scotland and other partners to drive forward the tobacco control agenda including through implementation of smoke-free legislation.

• NHSScotland's annual expenditure on waste disposal is currently in excess of £8m - the cost of 400 full time equivalent nurses. NHSScotland disposes of over 45,000 tonnes of waste each year of which 15,000 tonnes is categorised as clinical waste. Low/ medium clinical waste disposal costs are approximately six times more than domestic waste on a weight by weight basis. The introduction of landfill tax which increased to £15 per tonne in April this year reinforces the need to minimise the amount of waste sent to landfill sites by better segregation and recycling policy. NHSScotland Boards have in place plans to achieve reductions in the amount of waste.

• It is our policy to ensure that all NHSScotland bodies as an integral part of the commitment to the health and well being of the community do the utmost to ensure that all activities are sustainable. To deliver on this commitment all NHSScotland Bodies must have in place effective environmental management systems through which the environmental performance of property assets can be monitored and improved. NHSScotland's Property and Environment forum has developed an ISO14001 compliant system, known as Greencode. ISO 14001 is the international environmental management system standard. Greencode and the recently developed Corporate Greencode system which enables waste, fuel, energy and water use to be monitored at NHS Board level demonstrates our commitment to supporting NHSScotland in achieving a healthier environment and a healthier population.

NATIONAL HEALTH SERVICE

Spending plans 2002-08

Table 5.03 More detailed categories of spending (Level 3)

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Budget	2006-07 Plans	2007-08 Plans
NHS Board Unified Budgets 1
Argyll & Clyde NHS Board	394,180	430,901	489,309	514,833	-	-
Ayrshire & Arran NHS Board	345,407	381,031	433,747	462,840	-	-
Borders NHS Board	97,853	107,909	124,188	132,754	-	-
Dumfries & Galloway NHS Board	143,593	158,289	181,040	192,270	-	-
Fife NHS Board	296,302	327,187	376,032	399,619	-	-
Forth Valley NHS Board	236,627	260,798	298,669	314,943	-	-
Grampian NHS Board	431,776	469,159	513,841	547,910	-	-
Greater Glasgow NHS Board	898,543	974,225	1,079,286	1,137,979	-	-
Highland NHS Board	199,643	220,407	255,182	272,460	-	-
Lanarkshire NHS Board	480,614	528,622	602,127	637,338	-	-
Lothian NHS Board	646,472	702,539	772,948	812,864	-	-
Orkney NHS Board	19,720	21,578	23,861	25,740	-	-
Shetland NHS Board	24,074	26,184	28,522	30,876	-	-
Tayside NHS Board	382,951	414,943	450,643	483,539	-	-
Western Isles NHS Board	37,890	40,898	44,980	48,411	-	-
Special Health Board Unified Budgets 1
National Waiting Times Centre	11,831	16,000	29,820	34,256	-	-
Scottish Ambulance Service	106,733	117,166	128,100	143,056	-	-
Common Services Agency	150,206	161,723	175,000	194,480	-	-
NHS Quality Improvement Scotland	9,392	10,232	10,900	11,744	-	-
State Hospital	20,899	22,734	25,710	28,783	-	-
NHS 24	22,156	31,561	46,540	45,731	-	-
NHS Education for Scotland	182,538	198,836	215,670	289,157	-	-
NHS Health Scotland	8,130	9,512	11,140	12,017	-	-
Total available for NHS and Special Health Boards	5,147,530	5,632,434	6,317,255	6,773,600	7,957,790	8,459,182
National priorities
Cancer Services 2	25,000	25,000	25,000	-	-	-
Coronary Heart Disease/Stroke	-	10,000	20,000	15,000	15,000	15,000
Delayed Discharge	20,000	30,000	30,000	29,890	30,000	30,000
Drug Misuse expenditure by NHS Boards	19,677	19,677	19,677	25,752	25,752	25,752
Audiology services modernisation 2	-	-	4,000	6,000	6,000	6,000
Diabetes	-	-	-	550	1,000	1,250
Centre for Change and Innovation 3	4,925	12,798	14,693	21,060	24,252	23,640
Education and training
Education & Training	97,505	114,423	127,474	140,262	151,857	154,675
Primary care services
General Medical Services 3	452,712	500,827	545,408	649,792	-	-
Pharmaceutical Services	108,304	113,366	118,628	125,372	-	-
General Dental Services	203,222	213,299	225,176	253,565	-	-
General Ophthalmic Services	43,762	45,494	47,313	50,788	-	-
Resources still to be allocated for primary care services 4	-	-	-	-	508,415	561,206
Miscellaneous services
Research Support	31,940	33,599	35,348	37,504	43,104	47,604
Information Technology - revenue	16,512	19,679	36,821	35,301	65,301	100,301
NHS Central Register	1,200	950	950	950	950	950
Waiting Times Co-ordinating Unit	-	5,000	5,000	46,750	55,000	70,000
Glasgow Hostel	-	2,000	5,000	5,000	5,000	5,000
Distinction awards	14,529	17,716	18,425	19,162	19,928	20,726
Impairments	25,000	25,000	25,000	22,000	25,000	25,000
Miscellaneous Hospital & Community Health Services	6,119	46,628	36,657	16,621	19,020	19,975
National Health Service receipts	-94,691	-103,662	-104,178	-105,668	-105,668	-105,668
Capital investment
Capital	271,578	322,120	362,340	469,600	469,600	543,100
Capital receipts	-12,100	-12,100	-12,100	-12,100	-12,100	-12,100
Unallocated resources
Departmental Unallocated Provision	-	27,576	-	2,321	34,575	100,975
TOTAL NHS	6,382,724	7,101,824	7,903,887	8,629,072	9,339,776	10,092,568

Notes:
1. Indicative allocations for 2006-07 to 2008-09 are not yet available because the Arbuthnott formula will require to be updated for in-year changes.
2. From 2005-06 expenditure on cancer services has been included within NHS Board Unified Budgets
3. From 2006-07 General Medical Services has been included within NHS Board Unified Budgets
4. Individual allocations for demand led services have still to be decided. The resources available include the financial commitment made by the Executive in relation to the Action Plan for Improving Oral Health and Modernising NHS Dental Services.

What the budget does

Health Board pressures and developments

NHS Boards and Special Health Boards face a number of inescapable pressures and developments and the Department has made an assessment of these pressures which is set out in the following table.

Table 5.04 Cost of pressures and announced developments

	2005-06 £m	2006-07 £m	2007-08 £m	Notes
Increase in funding for NHS boards	561	534	501
Pressures and announced developments:
Consultant contract	16	18	19	Impact of pay inflation and pay scale progression
GMS ( GP) contract	69	-	-	Figures for 2006-07 and 2007-08 will not be known until the review of the nGMS contract, which is currently underway, is completed in Autumn 2005
GP out-of-hours arrangements	16	-	-	New out-of-hours arrangements will be in place by end of 2005-06 and we do not therefore predict significant additional costs beyond 31 March 2006
Agenda for Change	190	189	140	Covers pay inflation, pay progression and cost of unsocial hours arrangements on a 'cost neutral' basis (as agreed for AfC), but unsocial hours element subject to outcome of UK talks currently ongoing.
Junior doctors New Deal Contract	8	8	8	Impact of pay inflation
Price pressures	56	64	69	GDP on prices element of health board allocations
Capital charge revaluation	7	25	25
Secondary care prescribing	20	23	26
Staff and Associate Specialist doctors terms and conditions	-	4	2	Reflects cost of introducing a new contract from April 2006
Prescribing in primary care	45	91	101
Consultant growth	33	20	18
Nurse growth	41	22	17
AHP growth	10	11	9
GP growth	8	8	8
Total cost of pressures and developments	519	483	441
Remainder available for further developments	42	51	60

As can be seen from Table 5.04 there are still significant funds available for Health Board driven developments in 2006-07, once the cost of national developments are taken into account. In addition, the above table does not include other significant resources which will be passed to Health Boards for centrally driven developments such as £55m for meeting waiting times targets or £15m for CHD/Stroke developments. The above table does not take account of the savings announced in the Efficient Government Plan, published on 29 November 2004, which contains measures to deliver £166m of annually recurring cash-releasing efficiency savings by 2007-08. However, additional savings within the Health portfolio have been identified taking the target to £351m by 2007-08. Savings will be achieved by way of the implementation of a number of national and local savings programmes ranging from the Modernising of Support Services, which will deliver savings as a result of improved procurement and logistics services and the reform of financial processing and reporting and payroll services, through to the Improved Prescribing of Drugs by GPs and other independent prescribers. In addition to cash-releasing savings we have also identified £174m of time-releasing savings. All savings captured will be retained within individual board areas to re-invest in patient care services. From within the resources allocated to them, and the savings they are expected to achieve, we expect Health Boards to meet the medical needs of their local communities and to take forward local and national priorities.

Service improvements

We will continue to build on the directions set for the health policy and healthcare services in the White Paper on Scotland's health, Partnership for care, published in February 2003. The White Paper is about the promotion of good physical and mental health in the broadest sense and ensuring that the health service is fit for the 21 ^st century. At the heart of its vision is a culture of care that is developed and fostered by a new partnership between patients, care agencies, staff and the public.

A Partnership for a Better Scotland highlighted that improving Scotland's health is central to the welfare of our society. New initiatives are required to create a step change in improving health. We will take strong action to promote good health, introducing a range of measures to encourage safer, healthier lifestyles.

We will continue to secure improvements in Scotland's health services, placing the patient at the heart of how services are designed and delivered. We will work with NHS staff to improve the quality and consistency of care through national standards, inspection and support. However the National Health Service faces real challenges:

• an ageing population;

• changing and rising public expectations;

• rapid developments in medical science and technology;

• reducing staff hours, particularly for junior doctors, to reflect health and safety concerns; and

• an increased requirement on public health to respond effectively to new infections and biological, chemical or radiological hazards.

The Executive has built strong foundations for the future National Health Service in Scotland, and started on a path of major reform. Patients are concerned about the quality of care, treatment at the right time (with less waiting) and in the right place, having a say in decision making and getting clear explanations at every stage. At the heart of modernisation is designing services from a patient's perspective, and patients must be involved in and at the centre of that process.

Involving the public

The Executive has been developing new guidance on involving and engaging the public in service change which will be published shortly. We have set for the first time demanding targets for NHS Boards to achieve improvements in the involvement of the public in the planning and delivery of NHS services, and in the involvement of patients in decisions about their own health care and the development of services. We will expect the Scottish Health Council to monitor and report regularly on the progress being achieved.

Waiting times

Reducing waiting times for elective treatment continues to be an important part of our plans for change, for two reasons: quality of life and clinical outcomes will be improved overall through shorter waits; and patients consistently say that this is what they want from the NHS. We are seeking far more radical solutions than traditional waiting list initiatives. The NHS has already delivered on the Executive's target of no-one with a guarantee waiting for more than nine months for in-patient and day-case treatment by the end of 2003. The Service is also on course to deliver the shorter maximum wait target of six months for in-patient and day-case treatment and a six months maximum wait target for a first outpatient appointment by the end of 2005. Both these commitments will be reduced to 18 weeks from the end of 2007. For the first time, waiting times targets have been set for key diagnostic tests. From the end of 2007, the maximum waiting time for CT, MRI, Ultrasound and Barium Scans, Upper Endoscopy, Cystoscopy, Sigmoidoscopy and Colonoscopy will be nine weeks. From that date, no patient will wait more than 18 weeks for a first outpatient appointment or for inpatient/day case treatment. The nine-weeks standards for diagnostic tests will be included within these maximum waiting times - they are not additional. In primary care, the NHS will continue to offer access to a member of the primary care team within 48 hours of a patient contacting the GP surgery.

Delayed discharge

We also reaffirm our commitment to reduce the numbers of people who remain in hospital when ready for discharge because of a lack of community or home based health or social services. The number of patients inappropriately delayed in hospital for more than six weeks has reduced by 60% since the launch of the Delayed Discharge Action Plan in March 2002. This is a significant improvement and continuing investment in joint NHS/Local authority partnerships is expected to produce further reductions in delayed discharges. The challenge is to plan community care capacity for the future of our ageing population. Partnerships are developing a whole systems approach to tackling the problem to prevent avoidable admissions, facilitate appropriate rehabilitation and improve patient management processes.

Clinical standards

The development and monitoring of clinical standards for NHS Scotland will help us to improve the quality of patient care. NHS Quality Improvement Scotland has developed standards in key NHS clinical priority areas, and for clinical governance. It is currently developing new clinical governance and risk management standards, and will continue to extend and develop its approach to the quality assurance of clinical care. These standards will provide a key benchmark for measuring improvement in the delivery of care in the future, and we have set a new target for NHS Boards of achieving continuous improvement against the standards up to 2008.

Clean hospitals

Tackling infection in hospitals remains a key priority: we must ensure that hospitals are clean and safe places. The Chief Medical Officer's Task Force on Healthcare Associated Infection has taken a number of actions to further improve infection control, including endorsing a new code of practice on hospital cleaning services, and more work is in hand. NHS Quality Improvement Scotland has a key role in setting standards and inspecting hospitals' performance against these.

Community based services

A fundamental principle for us is that where healthcare services can be provided locally in a safe and effective way, they should be - while accepting that specialised services need to be grouped together into centres of expertise. Primary care services play a central part in the provision of NHS services to people in their local communities, close to home and close to where they work. For many people, their only experience of the NHS is in primary care, and indeed 90% of NHS care is provided a primary care setting. Many people rely on their GP practice, their pharmacist, dentist and optometrist to help them stay healthy, to provide treatment when they are ill, and to provide links to other services in the NHS either in the community or in hospitals, the voluntary sector or social care. The scope of professional practice is expanding across the professions which mean that a greater range of care and treatment is available in local settings. For example, nurses and community pharmacists are supporting the development of chronic disease management; and faster access to services is possible through NHS24 which provides telephone access to a health professional 24 hours a day for advice and support.

The National Framework for Service Change in NHS Scotland reinforces the overall policy direction that more care should be delivered locally. It underlines that patients should be at the centre of the delivery of responsive care and treatment, with more convenient services delivered more quickly at each stage of the patient's care, with services being as local as possible. As well as shorter waits and greater convenience for patients, the public wants reassurance that services are being delivered safely and sustainably; and communities want to know that services will be available locally wherever possible. Investment is already in place and will continue to support these policies and to boost capacity including infrastructure developments, to improve access and to increase the range of services which can be provided closer to where people live and work.

The establishment of Community Health Partnerships will play a fundamental role in the planning and delivery of primary care and community based services. The NHS Reform (Scotland) Act 2004 requires NHS Boards to establish CHPs as an effective basis for the delivery of local healthcare services, working in new ways with hospital services and at a community level with local authorities. The development of CHPs will expand and develop the range of services for local people by bringing healthcare into the community; harnessing the expertise of clinicians and allowing them to drive up quality and utilise their professional skills to the full. CHPs will directly influence NHS Board level strategic planning and plan primary and community based services with the full involvement of staff and delegated authority from the NHS Board to deliver services in the way that best fits the needs of local people. This will be on the basis of delegated authority with local control over the relevant budgets. It is expected that as far as possible delegation will continue to the frontline staff who are best placed to make day-to-day decisions about use of resources. A key part of this agenda is creating and strengthening local networks and partnerships with hospital and other specialist practitioners and teams to deliver integrated health services in areas such as chronic disease management.

CHPs will also work as the key NHS partner with local authorities and others, in particular the voluntary sector, in relation to Community Planning to tackle health priority issues; and act as the vehicle for developing and delivering joint approaches to local health improvement, healthcare and social care services for all ages. CHPs will engage members of the local community as partners in expanding the range and quality of health and social care services available locally. Public Partnership Forums will play a key role.

As well as changes in the organisation of NHS services with the development of 'single systems', including the development of CHPs, there are other significant developments underway as a result of the duty on NHS Boards to provide or secure 'primary medical services' for their population. NHS Boards have increased flexibility to use a range of contractual and delivery mechanisms to ensure primary medical services are developed and delivered in ways which reflect local circumstances and priorities.

The changes described above are complemented by modernised contracting arrangements in other areas of primary care; as well as strategic development of the infrastructure which supports an expanded range of services provided more locally. Examples of key areas of activity are given below. In all of these arrangements there is a greater focus on quality and the appropriate deployment of professional skills through teamwork.

The Right Medicine: A Strategy for Pharmaceutical Care in Scotland (Scottish Executive, 2002) provides a strategic framework for the development of community pharmacy including new contractual arrangements underpinned by an e-pharmacy programme. The drugs bill continues to be an area of significant activity in order to manage expenditure.

On 17 March 2005 the Scottish Executive published An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland. This Action Plan sets out the Executive's response to the two consultation documents Towards Better Oral Health in Children and Modernising NHS Dental Services in Scotland. The measures outlined in the Action Plan will address Scotland's poor oral health record, provide better access for patients, and provide an attractive package for the professional staff that the Executive wish to recruit to, and retain within, the NHS. Implementing these changes involves increased investment in NHS services and new and additional funding of £150m over three years has been provided for this purpose."

The role of primary care based nursing staff has undergone a number of developments in recent years as demonstrated by: Nursing for Health (Scottish Executive, 2001); Framework for Nursing in Schools (Scottish Executive, November 2003); and the Framework for Nursing in General Practice (Scottish Executive, October 2003). Work continues to develop the role of primary care nursing staff.

In March 2004 the Deputy Minister for Health and Community Care announced a Review of Eye Care Services in Scotland. The aim is to encourage the development of integrated eye care services to ensure patients receive a good quality and effective service, in a convenient setting without undue wait.

A Review of Community Hospitals is currently underway. The purpose of the review is to address the Partnership Agreement commitment to develop the important role of community hospitals, and to develop a strategy for sustaining small, rural and community hospitals where they are safe and effective, including the provision of minor surgery, and to act as a resource to GPs. The Review of Community Hospitals will support the implementation of significant elements of the National Framework for Service Change.

The Smoking, Health and Social Care (Scotland) Bill will give legislative effect to a number of these areas including a number of Partnership Agreement commitments such as free eye and dental checks.

Information management and technology (IM&T)

The provision of more services in the community means that the infrastructure has to be safe and clinically appropriate, provided in accordance with legislative requirements and good practice guidance, accessible for patients and the public. In addition to local investment, which is delivering an increasing number of new purpose built primary care facilities continued investment will further support joint working projects, 'community health service centre' projects, new 'dental centres' and premises extensions/improvements to support GP training. Work also continues in relation to IM&T to enhance patient care and support staff. For example, a functionality upgrade programme for GPIT is well underway, and the burden on GPs to provide and maintain infrastructure has been taken on by Health Boards. Almost all (99.8%) practices are computerised with supporting systems and the infrastructure to support and exploit electronic patient records in primary care is continually being enhanced, for instance by investment in scanners to help practices go paper light, phasing in of a generally available emergency care summary, ongoing work to improve the process for transferring patient records, and investment in the e-pharmacy programme. This is all designed to pave the way towards the introduction of a single patient record accessible to all clinicians, not just those in primary care.

National Waiting Times Centre

The Golden Jubilee National Hospital in Clydebank has played an important role in providing additional facilities for planned surgery and other patient procedures since it was purchased for the benefit of NHS patients in summer 2002. The number of procedures performed at the hospital has grown ahead of forecast. Further investment is planned to ensure that the most intensive use possible is made of the surgical and diagnostic facilities at the Golden Jubilee.

Pay modernisation

The implementation of pay modernisation through the new Consultant and GMS contracts and Agenda for Change represents a major investment in our NHS workforce. These three strands share a common goal - to reward, motivate, and free up staff to deliver re-designed and improved services to patients. We expect delivery of these contracts to link closely with the Department's overall policy objectives for NHS Scotland with a particular focus on improved productivity, enhanced services to the public, service re-design around the needs of patients, improved recruitment and retention and improved management and development of staff.

Pay modernisation is a toolkit which helps and supports systems to deliver on a wide range of key NHS priorities in securing sustainable, safe, and effective changes to service provision. It is also a driver for positive culture change in the NHS in behaviours, attitudes, and ways of working which will be of long term benefit to both staff and patients. The Department has asked Boards to provide pay modernisation benefits delivery plans which will demonstrate, using specific and measurable indicators, how introduction of the new contracts is delivering better services to more people more quickly than before.

Agenda for Change commenced implementation in December 2004. The current focus is on matching and evaluating and assimilating over 140,000 NHS Scotland staff to the new system. The size and complexity of this task is acknowledged, as is the level of commitment demonstrated by those in NHS Scotland, both staff and management, who have been working together in partnership to bring in the new arrangements. The Scottish Pay Reference and Implementation Group is tracking progress on a monthly basis and providing support and assistance to Boards as they introduce the new system.

The new Consultant Contract was introduced from 1 April 2004 and over 90% of consultants now have agreed job plans. There is now emerging evidence of positive change flowing from the job planning processes associated with the contract, including more efficient use of consultant resource for the benefit of patient care.

The nGMS Contract was also fully introduced from 1 April 2004. The new contract encourages recruitment and retention in the GP workforce through better management of GP workload, investment in primary care infrastructure, and by transferring responsibility for out-of-hours services to Health Boards.

This contract also links GP payments to the quality of care that they provide for patients, through the Quality and Outcomes Framework ( QoF). This Framework is realising significant benefits for patient care and clinical outcomes in the primary care sector. The first cycle of QoF data, published in May 2005, showed a high level of achievement in the provision of quality care to patients across Scotland, a reflection of considerable improvements made by practices over the previous year.

The Contract is currently being reviewed on a UK-wide basis, with a view to putting in place a revised set of arrangements from April 2006. The levels of investment to underpin these arrangements have not yet been determined and are subject to the outcome of the UK review, which is expected to complete its work in autumn 2005.

We do not anticipate at this stage further cost pressures arising from new out-of-hours arrangements in addition to the pressures already identified for 2005-06.

Workforce planning

Effective strategic workforce planning is key to ensuring that we secure the right workforce in the right place at the right time for NHSScotland. This is being carried out as part of a broad workforce development function by workforce planners at local, regional and national level. The NHS Reform Act enshrines this function in statute by requiring NHS employers to put in place arrangements for workforce planning as part of their wider staff governance responsibilities.

At local level NHS Boards are expected to plan the future workforce for their geographic area of responsibility. At regional level, three workforce regions (North, South East & West), led by regional workforce directors, have been established to help develop Board workforce plans and to co-ordinate regional workforce plans, while nationally SEHD's National Workforce Unit provides leadership and direction to NHSScotland on workforce planning. SEHD will be publishing The National Workforce Plan 2005- A Framework for NHSScotland, outlining the framework within which strategic workforce planning is operating, in August 2005.

We are committed to working with Boards to deliver staff increases across a number of staff groups, reflecting the Executive's Partnership Agreement commitments (although it is important to note that the recruitment and retention of staff is an operational NHS employer responsibility under the control of NHS Boards, and subject to the operational and financial priorities faced by Boards). There are 13 specific workforce commitments, 4 of which have specific workforce number targets:

• We aim to increase the number of consultants in the NHS by 600 by 2006 and continue to build on that increase thereafter. The consultant expansion programme has resulted in a total of 180 consultants being recruited between September 2002 and September 2004. Work is underway to put in place a range of recruitment and retention initiatives to build on this in the short and longer term by increasing the numbers of doctors coming through training and taking up employment in NHSScotland.

Significant increases in Specialist Registrar posts, which feed consultant posts, have already been made. SEHD has also identified long-standing consultant vacancies in NHSScotland and will work with employers and NHS Education for Scotland ( NES) to ensure better matching of consultant vacancies to training-grade doctors coming through the 'supply chain.' SEHD is in addition discussing with NHS Education for Scotland the scope for streamlining the management of Specialist Registrar feeder posts to ensure capacity continues to grow at the appropriate rate. The new GMS Contract provides a package of measures to aid recruitment and retention of GPs and SEHD will consider carefully the number of GP Registrars required in 2006-07 to ensure sufficient training grade numbers to fill future GP vacancies, taking into account the impact of Modernising Medical Careers.

• We will bring 12,000 nurses and midwives into the NHS by 2007. This is a recruitment target supported by a range of initiatives taking place under the banner of the nurse recruitment and retention initiative Facing the Future, including the return to practice scheme, the one-year work guarantee and increases in the number of students entering training.

• We will treble the existing numbers of nurse consultants to fifty-four. Forty nine posts have been established, vacant or approved.

• We will ensure a total of 1,500 extra allied health professionals. SEHD's strategy for allied health professionals Future Directions, which outlines a range of recruitment and retention initiatives, contributes to the delivery of this target.

Dentists

In addition to these targets, SEHD is currently investigating the options for addressing the shortfall in the number of dentists in some areas of Scotland. Work is in hand to increase the numbers of dental students and a range of recruitment and retention strategies has been put in place to increase dental numbers in NHSScotland, including through golden hello payments. These payments range from an allowance of £3,000 to each newly qualified dentist taking up their vocational training year in Scotland to an allowance of £10,000 over two years to dentists entering substantive general dental service practice in Scotland within three months of completion of training. The increase in dental training capacity will be supported by more outreach training, including a new centre in Aberdeen.

National framework for service change

Work is also being done within SEHD to identify longer term influences on health service provision and demand and how this relates to workforce development. The NHS is going through a period of extensive redesign and the Scottish Executive's response to Building a Health Service Fit for the Future can be expected to drive fundamental changes to the way we staff the service. The workforce aspects of these trends will be addressed through the new workforce planning arrangements.

Integrating services

The Health Service will be improved through clear natural strategic direction and the full involvement of staff. We will give front line staff the support, the tools and the freedom to innovate, lead change and make things better. We will develop and support our workforce to deliver the improvements in the provision of patient focused services that we seek. In this way, we shall provide services that better meet patients' needs, guarantee levels of service, raise service standards and address inequalities in health provision within communities and across the country. This is already being done in our cancer strategy and in our coronary heart disease and stroke strategy. These will strengthen the skills and equipment available in key areas. Decisions about investment priorities and service redesign will be matters for frontline staff in partnership with patients. Complementing decentralisation and power to front line staff is a strong emphasis on integration and partnership. Our aim is to bridge the gap between primary and secondary care and between health and social care. IT developments and better overall communication between primary and secondary care are essential to integration, but we are going further through Managed Clinical Networks, Managed Care Networks and other forms of joint working.

Learning and development

In 2005-06 we will continue to develop access to continuous learning and development through the increased access to e-learning through the partnership with SufI (LearnDirectScotland), as outlined in the Partnership Agreement. The Balanced Working Lives Programme includes conferences; workshops for clinical team leaders and workbooks and is designed to spread good practice in flexible working so that staff are supported with learning. A project manager has been appointed to support and enhance the work undertaken on nursing and midwifery workloads by the Facing the Future Group. Work will include a mapping exercise and looking at the methodologies used to measure the quality of care and collating examples of good practice in workload assessment. We will continue to support NHS employers with retention of staff by encouraging the implementation of PIN guidelines and continuing to monitor success with good people management practices through the staff survey and other Staff Governance tools. We will continue to develop NHS Scotland as an exemplar employer to best position Health Boards in the global labour market and enhance capacity to recruit staff.

Single electronic patient record

Significant additional resource is planned to support the introduction of the single electronic patient record. This will require investment in an infrastructure to support the single record including improved broadband network services, access to flexible workstation facilities such as wireless notepads, patient and staff authentication facilities and resilient 24 X 7 systems delivery. All of this is needed to support resource allocation in support of patient care and best care practice by multi disciplinary teams.

Children and young people

We will deliver an Action Framework for Children and Young People in Scotland which will include Tertiary Services, Secondary Care, Health for all Children (Hall4), Children and Adolescent Mental Health Services, Emergency Care for Children and Young People and the integrated children's services agenda.

BoardNHSArgyll and Clyde

Following a review and report by the Audit Committee of the Scottish Parliament on the financial situation of NHS Argyll and Clyde, which predicted that the cumulative deficit carried by the Board of £60m would rise further, Ministers announced in May 2005 that they intended to provide additional funding to clear off the deficit, up to a maximum of £80m. At the same time they would bring forward proposals for approval by the Parliament after consultation with the public to redraw the boundaries of neighbouring health boards to absorb the present NHS Argyll and Clyde area. The public consultation began in August and it is expected that the boundary changes will take effect from April 2006.

Delivery

The Executive's role is to help ensure that the NHS delivers Ministers' priorities for the NHS and to support the Service in making the necessary changes. Firstly we are providing the resources. Secondly, we have established national priorities with a limited number of critical targets that Boards must meet, together with support for NHS planning and delivery through a new approach announced by Ministers at the end of July. Thirdly we are ensuring that the new quality agenda of national standards is developed and implemented. Fourth, we are bringing about a step change in our workforce planning and workforce development arrangements. Fifth, we have established new contractual arrangements for the NHS workforce which provide a platform for modernisation and reform. And sixth, we have established and maintained a culture of partnership working and effective people managements which is supported by the introduction of the Staff Governance Standard into legislation and national partnership through bodies such as the Scottish Partnership Forum, who input into strategic service issues, and the Human Resources Forum, who take the lead around key strategic human resource issues. SEHD remains committed to working in partnership with staff organisations and NHSScotland management as it takes forward its programme of reform and modernisation. It is currently embarked on a stocktake of existing partnership arrangements. It is intended that this should conclude by October 2005.

The Department has a range of mechanisms available to secure delivery of Ministerial objectives around performance, service redesign and improved quality and service delivery. These include the capacity to deploy additional resources through for example the Change and Innovation Fund, the ability to withhold or claw back funds from NHS Boards where delivery plans are not in place or not progressing according to plan, independent monitoring of compliance with national clinical standards and escalating intervention protocols for use in the event of serious service or administrative failure. Ministers' announcement at the end of July of a new focus on delivery in the Health Department will secure further improvements in delivery performance through a closer alignment between the Department's efforts and resources and Ministers' priorities for the NHS.

The NHS Reform (Scotland) Act 2004 gave new duties to NHS Boards to consult the public and to plan in co-operation across NHS Board boundaries. It also gives Ministers new powers of intervention where there is evidence of service failure. Although these powers would be used only as a last resort, the Act makes clear that Ministers may if they choose send in a suitably-experienced task force to take over the running of failing health services, with the aim of getting services working again as soon as possible.

NHS Quality Improvement Scotland is spearheading the quality agenda. This involves giving advice and support to the NHS, the development of national standards and inspections against those standards, not only for specific diseases but also in the vitally important area of hospital acquired infection and clean hospitals. NHS Quality Improvement Scotland is also developing a quality assurance framework for managed clinical networks to ensure that they are effective in delivering improved services and care.

NHS Boards are already taking forward much of this agenda in their forward plans, and in their joint working with Local Authorities, Community Planning Partnerships, staff and clinicians, and with patients and the public. The Performance Assessment Framework now in place highlights progress and our Annual Accountability Reviews with NHS Boards give us all the opportunity to monitor progress and adjust forward plans.

Our approach is about enabling and encouraging continuous improvement and good performance, but where there is continued poor performance Ministers have sanctions open to them. The Accountability Review process enables Ministers through the Health Department to publicly highlight to individual NHS Boards areas where performance must be improved. Resources can be allocated to particular issues and conditions attached to the use of resources. Task forces and support teams can also be directed into particular problem areas. Minister can of course, replace the Chair or non-Executive directors of NHS Boards.

OTHER HEALTH SERVICES

Spending plans 2002-08

Table 5.05 More detailed categories of spending (Level 3)

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Budget	2006-07 Plans	2007-08 Plans
Training for Prosthetists & Orthotists	2,971	3,120	3,200	3,230	3,322	3,365
Grants to Voluntary Bodies	2,246	2,296	2,296	2,645	2,395	2,395
Genetic Services	-	-	-	-	5,000	5,000
Miscellaneous Other Health Services	13,978	13,912	11,417	10,119	10,438	10,443
Research	12,696	13,443	14,624	15,364	15,514	15,514
Welfare Foods	14,000	14,000	14,000	11,000	15,000	15,000
Mental Health Act Implementation 1	1,504	4,543	9,703	17,553	20,553	21,053
Scottish Low Income Scheme Administration	902	952	990	1,030	1,030	1,030
Other Health Service receipts	-826	-918	-280	-180	-190	-190
Total	45,967	51,348	55,950	60,761	73,062	73,610

Note:
1. This line now includes the Mental Welfare Commission's expenditure.

What the budget does

The Chief Scientist's Office promotes high quality research aimed at improving the services offered by NHSScotland, and the health of the people of Scotland. It directly funds research chiefly on the priority areas of coronary heart disease/stroke, cancer, mental health and public health. Effectiveness in research funding is ensured by a process of external peer review across the range of activities. The relevance of research is a key criterion in the assessment process, and efficiency is achieved by external scrutiny of research costs at the outset and regular monitoring throughout the life of a project or initiative.

In 2006-07, research resources will be focused on:

• funding research projects with direct relevance to the Health Service;

• participating in the development of clinical trials to deliver improvements to the Health Service through the UK Clinical Research Collaboration ( UKCRC);

• ensuring that the scientific objectives of the Genetics and Healthcare Initiative, a collaboration between the Scottish Executive's Health and Enterprise departments to support research into the causes of genetic diseases, can be appropriately exploited to improve understanding of disease, thus directly benefiting the Scottish Biotechnology Industry as well as providing economic benefits by improving health;

• participating in the UK Biobank initiative, a long term research programme which plans to collect baseline data from 500,000 participants and to regularly follow up each participant and record health events. Biobank will thus provide an invaluable research resource that should enable epidemiologists to predict disease risk in sub-populations and identify disease biomarkers that will allow clinicians to improve the specificity of interventions;

• extending nursing involvement in cancer clinical trial activity to the early testing of novel anti-cancer drugs and the banking of cancer tissue for National Translational Cancer Research Network activities;

• implementing an £8m partnership initiative between SHEFC/ NES/ SEHD for research capacity building amongst nursing and midwifery and allied health professions; and

• ensuring Scottish Health Innovations Limited maximises the appropriate exploitation of technologies.

Following a comprehensive review of the Welfare Food Scheme, a new scheme, called Healthy Start will be introduced throughout UK during 2005-06. Replacing tokens for liquid milk and infant formula milk, eligible people will receive vouchers which can be exchanged for fresh fruit and vegetables as well as milk. The aim is to ensure that all young mothers (those under 18), and also targeted to lower income families offers support for pregnant women, nursing mothers and young children with a wide choice of healthy eating options. Also this scheme now supports those who choose to breastfeed with these flexible tokens. Scottish Ministers will be able to prescribe the types of food that will be available in Scotland.

The Mental Health Act implementation funding, which includes expenditure by the Mental Welfare Commission, will support various aspects of the implementation of the new Mental Health (Care and Treatment) (Scotland) Act 2003. This will include publication of the Code of Practice and topic guides on the Act; the establishment of the new Mental Health Tribunal for Scotland (which will hear applications for and appeals against compulsion) and research into the operation of the new Act to inform the implementation process. These resources will help ensure that the Act, once it is brought into effect, will deliver real benefits for service users and those who care for them. The Mental Welfare Commission for Scotland protects the interests of people with mental disorders by conducting inquiries, hospital visits, and meeting with patients, relatives and carers, and people subject to Community Care and Guardianship Orders.

We will continue to implement the Partnership Agreement to further develop and improve mental health services that focus on promotion, prevention, protection, quality, care and recovery. We will continue to promote and support a joint approach to delivering a spectrum of care from specialist hospital care to care in people's own homes and communities.

HEALTH IMPROVEMENT

Spending plans 2002-08

Table 5.06 More detailed categories of spending (Level 3)

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Budget	2006-07 Plans	2007-08 Plans
Health Improvement 1	26,714	38,386	45,218	43,742	45,907	46,031
Bloodborne virus 2	6,646	6,659	8,826	8,997	9,267	9,545
Flu prevention	-	-	-	11,400	11,400	3,600
Tobacco and smoking	-	-	-	9,800	11,800	13,800
Mental wellbeing 3	-	5,000	4,773	5,847	9,298	9,481
Sexual Health	-	-	-	5,000	5,090	5,180
Drugs misuse	3,658	5,161	7,084	6,222	6,441	6,666
Total	37,018	55,206	65,901	91,008	99,203	94,303

Notes:
1. In addition to the above directly funded expenditure, significant spending on health improvement is carried out by NHS Boards through their unified budgets.
2. Formerly called Health Promotion AIDS and now includes the " AIDS prevention" expenditure.
3. The "Mental wellbeing" figures for 2003-06 do not include funding allocations to Local Authorities, which were held on behalf of Community Planning Partners for local actions in support of the 'Choose Life' Suicide Prevention Strategy. This funding was transferred to Local Government Finance Division as part of General Allocated Expenditure. Budget figures for 2006-08, however, include the £3.198m of 'Choose Life' funds which will be held by Mental Health Division.

What the budget does

The overall strategy for health improvement was set out in Improving Health in Scotland: The Challenge. The strategy includes:

• a programme of co-ordinated action aimed at improving life expectancy by addressing life circumstances, risk factors and priority health topics;

• better communication, higher profile and more focused delivery; and

• sustained action across four key settings: the early years, the teenage transition, health of working age people and community based health improvement.

The Challenge also has an overarching aim of tackling the health inequalities that persist in Scotland.

Successful improvement in health requires complex, multi-stranded actions to: promote safer, healthier lifestyles; improve diet and levels of physical activity; tackle the problem of alcohol abuse; address the health of homeless people; improve mental health and well-being, and co-ordinate initiatives to promote good physical and mental health in the workplace.

Along with the Scottish Executive, the NHS including NHS Health Scotland, COSLA, local government, the voluntary sector, the private sector and Community Planning Partnerships have key responsibilities to lead this programme and deliver services both alone and in partnership to improve health.

We will continue to support community planning as the key framework for developing a joint plan for health improvement in a local authority area. Working in partnership with NHS, local authorities will lead the development of Joint Health Improvement Plans and will include input from all Community Planning Partners. NHS boards' local health plans may incorporate one or several joint health improvement plans. NHS Local Health Plans will also reflect regeneration outcome agreement priorities.

Similarly, the views of health professionals and a range of stakeholders are helping to shape the scope and structure of a reorganisation of health protection arrangements in Scotland. This reorganisation has been caused primarily by the need to ensure a cohesive, integrated response to the major health problems caused by exposure to biological, chemical, radiological and physical hazards and the challenges of new and re-emerging infections.

COMMUNITY CARE

Spending plans 2002-08

Table 5.07 More detailed categories of spending (Level 3)

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Plans	2006-07 Plans	2007-08 Plans
Grants to the voluntary sector	2,097	2,327	2,327	2,537	2,595	2,655
Scottish Commission for the Regulation of Care	6,500	15,862	19,615	16,515	16,285	16,285
Minor expenditure	165	160	-	-	-	-
Total	8,762	18,349	21,942	19,052	18,880	18,940
Mental Health Specific Grant	13,300	14,000	14,000	14,000	14,000	14,000

What the budget does

We are committed to delivering a wider variety of flexible person-centred care services to help more people live independently for longer within the community, and so improve social inclusion. We have set out four national outcomes for which local partnerships are developing local improvement targets. We continue to support local authorities and the NHS in driving forward the Joint Future agenda and to reduce delayed discharges.

Local Authorities spend around £1.6 billion a year on these services, of which around £1 billion a year is on older people (65 or over), and employ 33,900 staff in adult Community Care services. Additional provision is being made available for local authorities through the GAE baseline for health and community care. This will provide significant extra resources for services for older people, whose numbers are expected to increase quite quickly in the years ahead.

With the pressures of an ageing population, we will continue to invest in social care services, through local authorities and the voluntary sector, with the aim of delivering a wider variety of flexible person-centred services to help more people live independently for longer in their own homes or in sheltered housing, and to reduce inappropriate admissions and inappropriate length of stay in hospitals. At any one point in time, local authorities maintain 53,600 older people (65 or over) every day in their own homes with home care services, and support another 33,400 older people (often those over 80) in 980 care homes. They also give services to 18,000 adults with learning disabilities, and support wholly or mainly 900 adults with mental health problems in care homes, and give home care services to 2,200 such adults.

The new Social Work Inspection Agency will inspect community care services across Scotland. The Chief Inspector's annual report will inform Ministers of local authorities' progress towards objectives and standards of delivery.

The Executive is continuing to invest in community care services, making provision through Grant Aided Expenditure for an additional £107m of local authority funding in 2006-07, rising to £182m in 2007-08, to expand services in response to increasing demand and to support improvements in quality of care.

• £37.1/£57.5m (in 2006-07 and 2007-08) to meet pressures on care home fees and bring stability to the care home sector.

• £16.3/£42.0m to provide care for the increasing numbers of older people.

• £17.0/£27.0m for staff training to improve quality of care and meet new requirements for workforce registration.

• £12.7/£15.0m to provide faster access to homecare, contributing to the Executive's target of increasing the proportion of older people receiving intensive home care to 30% of all those receiving long term care, by 2008.

• £10.3/£13.6m to improve the quality of care provided through the voluntary sector, meeting requirements for care standards, and for staff training and development.

• £4.2/£5.0m to deliver additional services and support for people with learning disabilities in the community, following the resettlement programme set out in The same as you? learning disability review.

• £1.8/£2.0m to alleviate waiting lists for self directed care through direct payments and increase uptake.

In relation to the Executive's direct expenditure on community care, as set out in Table 5.06 above:

• The Executive awards grants under Section 10 of the Social Work (Scotland) Act 1968 to support a range of national voluntary sector organisations working in the Community Care field; and

• The Executive supports, through Grant-in-Aid, the Care Commission, which was established on 1 April 2002 to regulate a wide range of care services throughout Scotland against the provisions of the Regulation of Care (Scotland) Act 2001 and the National Care Standards. The Commission is also financed through fees charged to registered services.

We will continue to support Mental Health Specific Grant which provides £14m, supplemented by £6m from local authorities, to support around 400 small scale but valued community based projects, all helping people with mental health problems. Projects include: drop-in centres; counselling services; and education and employment schemes.

OTHER HEALTH AND COMMUNITY CARE RELATED LOCAL AUTHORITY FUNDING

Spending Plans 2002-08

Table 5.08 More detailed categories of spending (Level 3)

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Budget	2006-07 Plans	2007-08 Plans
Home Based Elderly	314,383	420,865	442,604	467,247	495,170	518,244
Residential Accommodation Elderly	294,946	310,902	326,577	342,691	357,529	373,029
Services for the Disabled	260,772	278,927	290,684	302,769	320,577	328,956
Care Home Fees	-	24,000	62,646	62,646	99,768	120,099
Environmental Health	62,405	65,567	68,049	70,611	67,616	68,149
Other Health and Community Care	271,077	356,206	383,302	424,322	433,737	441,567
Total	1,203,583	1,456,467	1,573,862	1,670,286	1,774,397	1,850,044

What the budget does

The Health and Community Care Grant Aided Expenditure ( GAE) figures relate to the level of local authority net revenue expenditure on these services that the Executive is supporting through grant. GAEs are not budgets, but more a basis for the distribution of grant through Aggregate External Finance ( AEF). Local authorities are, however, free to allocate their available resources to each service, including Health and Community Care, on the basis of local need. The figures in this table are included in the GAE summary table (Table 10.04) contained within the Finance and Public Service Reform chapter of this document.

FOOD STANDARDS AGENCY SCOTLAND

To protect consumers by improving the safety of food and by giving honest, clear information. We will make it easier for people to choose a healthy diet.

OBJECTIVES AND TARGETS

Objective 1		To achieve a further reduction in the occurrence of foodborne illness and to protect consumers from risks arising from chemical and radiological contamination. Also to help those with food allergies and intolerances make the choices they need to make.
Target	1	FSAS will promote and encourage documented Food Safety Management Systems in food businesses. In particular, we will improve standards in the catering industry by providing support to 8,000 catering businesses by 2007.
Target	2	FSAS will reduce the incidence of Campylobacter positive produced Chickens in Scotland by 22% by 2008.
Target	3	FSAS will reduce the incidence of Salmonella positive Scottish pigs at slaughter in Scotland by 30% by 2008.
Objective 2		To help to reduce diet-related diseases and encourage consumers to choose a healthy diet by making healthy eating an easier option.
Target	4	Working in Partnership with the SE, the FSAS will contribute to a reduction in the salt intake of Scottish adults from 9.5g to no more than 6g per day, and reduce salt intake of children in line with the Scientific Advisory Committee on Nutrition (age-specific) recommendations by 2010.
Target	5	FSAS will work with departments across the SE to set standards for products used in school meals for full implementation by 2007. The FSAS will also work in partnership to set standards for product specifications for other sector groups (hospitals, prisons, nurseries, looked after children and elderly in care) by 2007, in order to help meet Scottish dietary targets.
Objective 3		To make it easier for consumers to make informed choices.
Target	6	FSAS will contribute to the development of guidance to ensure that Scottish consumers are provided with information with is helpful to them, that is accurate and does not mislead. Specific issues to be addressed are allergens in food, assurance schemes and understanding of 'use by' information.
Target	7	FSAS will assess how the new GM labelling regulations that have applied since April 2004 work in practice for Scottish consumers and use this information as part of the UK's input to inform the European Commission's review of these regulations in 2006.

Spending Plans 2002-08

Table 5.09 More detailed categories of spending (Level 3)

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Budget	2006-07 Plans	2007-08 Plans
Food Safety	2,753	3,111	6,320	6,449	6,779	7,109
Eating for Health	1,431	1,586	1,804	1,856	1,951	2,046
Choice	1,321	1,403	1,476	1,466	1,541	1,616
Total	5,505	6,100	9,600	9,771	10,271	10,771

Table 5.10 More detailed categories of spending (Level 3 real terms)at 2005-06 prices

£000s	2002-03 Budget	2003-04 Budget	2004-05 Budget	2005-06 Budget	2006-07 Plans	2007-08 Plans
Food Safety	2,957	3,255	6,478	6,449	6,601	6,740
Eating for Health	1,537	1,660	1,849	1,856	1,900	1,940
Choice	1,419	1,468	1,513	1,466	1,500	1,532
Total	5,912	6,383	9,840	9,771	10,001	10,212

What the budget does

We will deliver a measurable increase in public confidence in the way food safety and standards are managed in Scotland by increasing the profile of the Agency through further media activity as part of the Food Hygiene Campaign. We will make sure that issues of public concern are debated openly and that our advice and information is freely available by holding open Scottish Food Advisory Committee meetings and attending a range of public events such as the Royal Highland Show. In everything that we do, we are committed to ensuring that we work to grow the economy, to promote equality and close the opportunity gap and to ensure that our activities are sustainable.

Statement of Priorities

Food Safety will continue to be the main priority of the FSAS. However, action must be taken to reduce diet-related diseases. To achieve this, we will promote Eating for Health. We want to make sure that the next generation has a better understanding of all aspects of food. It is a priority of the FSAS to help children have a healthy diet and handle food safely by giving them the necessary skills and information.

Choice plays a vital role in our work on safety and standards and in helping people to eat healthily. However, whatever the individual choice, consumers must not be misled by what they are buying.

In 2006-07, we will focus our resources on:

• delivering a measurable reduction in foodborne illness, contributing to the overall UK target of a 20% reduction by 2006, by focusing on the implementation of Food Safety Management Systems across food businesses, concentrating on caterers;

• working in partnership with the SE and other organisations to improve the evidence base on diet and nutrition in Scotland and further support the implementation of the Scottish Diet Action Plan;

• increasing research and surveillance into food poisoning organisms such as Campylobacter and identifying ways of minimising risks;

• working with the Scottish Executive Health Department to reduce the average intake of saturated fat by 2010; and

• reviewing our current approach to protecting consumers from food fraud and illegal practices.

Growing the Economy

The activities within the Agency that promote consumer confidence, Food Safety Management Systems and Eating for Health all have a positive impact on the Scottish economy. With the trend towards eating out of the home, the support for the implementation of Food Safety Management Systems will boost consumer confidence in the safety of food consumed outside the home. This will support the continued growth in this market segment and the tourist industry in particular. Food Safety Management Systems are also reported to have a positive impact on the financial performance of businesses by reducing waste, improving stock control and assisting customer retention.

The Eating for Health theme will contribute to improving the long-term diet of the Scottish population. This will have a positive impact through promoting a healthy workforce.

Closing the Opportunity Gap/Promoting Equality

The Food Standards Agency is committed to the long-term improvement of health of the Scottish population. In establishing a sound evidence base the Agency is committed to:

• focusing on nutrition, health benefits and hygiene education that will form life skills for children and young people;

• facilitating access to healthy and nutritional food for disadvantaged groups;

• improving food labelling to allow consumers to make informed choices about their diet and the food they buy; and

• ensuring that all our information is accessible across all groups including minority ethnic communities and the socially disadvantaged.

Sustainable Development

The agency is committed to conserving energy, water and other resources, reducing waste and minimising the release of greenhouse gases. We have an active recycling policy achieving recycling of over 85% of office waste. Future procurement will aim to minimise supplies that are dependent on the use of non-renewable resources or pollutants. The Agency has developed a mechanism and guidance based on the UK Government Integrated Policy Appraisal ( IPA) framework that was developed jointly by a number of government departments and which will be embedded in all areas of policy development.

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