The Health Department's aim is 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.
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. Every year cancer, coronary heart disease and strokes account for 65% of all deaths in Scotland. These are all diseases which are increasingly preventable by less smoking and improvements in physical activity and diet. Earlier diagnosis and treatment are vital to ensure optimal outcomes. In addition, treatment provided by multi-disciplinary clinical teams organised across managed clinical networks is key to ensuring continuous improvements in the quality of healthcare services.
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.
A final report on the key performance targets set in the 2002 Spending Review is set out below.
Target 1
(ONGOING) | Achieve a 50% reduction in death from coronary heart disease in people under 75 between 1995 and 2010. |
To date, there has been a 43.6 % reduction in the coronary heart disease rate, from 124.6 in 1995 to 70.3 in 2004. The current projection to 2010 suggests that the new target of 60% will be achieved with a 61% reduction between 1995 and 2010. This target was replaced in the Draft Budget 2005-06 with a new target: "Reduce the mortality rates for those aged under 75, between 1995 and 2010 by health improvement action to tackle diet, physical activity, smoking and alcohol consumption, by action to ensure early detection and improved access to treatment and care. We will reduce deaths due to cancer by 20%; coronary heart disease by 60%; and stroke by 50% by 2010." |
Target 2
(ONGOING) | Achieve a 20% reduction in death from cancer in people under 75 between 1995 and 2010. |
A 14.8% decrease in the number of deaths from cancer, in people under 75, has been achieved between 1995 and 2004 (latest available data). Projections for the next 6 years suggest that the target will be exceeded with an overall 23.0% reduction being achieved between 1995 and 2010. This target was replaced in the Draft Budget 2005-06 with a new target: "Reduce the mortality rates for those aged under 75, between 1995 and 2010 by health improvement action to tackle diet, physical activity, smoking and alcohol consumption, by action to ensure early detection and improved access to treatment and care. We will reduce deaths due to cancer by 20%; coronary heart disease by 60%; and stroke by 50% by 2010." |
Target 3
(ONGOING) | Achieve a 50% reduction in deaths from cerebrovascular disease (stroke) in people under 75 between 1995 and 2010. |
There has been a 40% reduction in the rate of deaths from strokes, from 37.5 in 1995 to 22.5 in 2004. Current projections suggest that the target will be achieved with a 55.3% reduction achieved between 1995 and 2010. This target was replaced in the Draft Budget 2005-06 with a new target: "Reduce the mortality rates for those aged under 75, between 1995 and 2010 by health improvement action to tackle diet, physical activity, smoking and alcohol consumption, by action to ensure early detection and improved access to treatment and care. We will reduce deaths due to cancer by 20%; coronary heart disease by 60%; and stroke by 50% by 2010." |
Target 4
(ONGOING) | Achieve a reduction in smoking from 35% to 33% between 1995 and 2005 and to 31% by 2010. |
Reducing the toll that smoking takes on Scotland's health has been a key priority for the Executive. 'A Breath of Fresh Air for Scotland', the first ever tobacco action plan designed specifically for Scotland was published in January 2004. The Action Plan set out 20 action points including prevention and education, and the expansion of quality smoking cessation services. It also addressed the issue of passive smoking, which led to the landmark public health legislation on smoke-free public places being introduced in Scotland in March 2006. Funding of smoking cessation services was more than doubled and will rise to £11million by 2007-08. In view of this considerable increased investment and the cultural shift that we believe the smoke-free laws will help deliver, the Executive have set a challenging new target to reduce the smoking prevalence for all adults aged 16+ to 22% by 2010. The original 2005 target for a reduction from 35% to 33% (for adults aged 16-64 years old) was achieved two years early. The 2010 target was rebased in January 2006 to reduce smoking prevalence from 26.5% to 22% between 2004 and 2010 for all adults aged 16+. In addition to the target above, a new inequalities target was set in the Draft Budget 2005-06 to: "Reduce health inequalities by increasing the rate of improvement across a range of indicators for the most deprived communities by 15% by 2008. (the range of indicators has been selected from the 23 recommended indicators of health inequality. For adults - coronary heart disease, cancer, adults smoking, smoking during pregnancy and for young people - teenage pregnancy and suicides in young people)." |
Target 5
(ONGOING) | 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. |
Record levels of investment continue to be made (£10 million 2005-06 and 2006-07) in the provision of treatment and prevention services to ensure that people are educated in responsible drinking practices; and that services are available and accessible to those for whom alcohol related harm is already a reality. The 2003 Scottish Health Survey - which is the most recent information source available to track progress against the 2005 target and which is used to estimate the prevalence of health conditions and health-related behaviours and to monitor progress towards the Scottish Executive's health and dietary targets - reported in November 2005. This showed that 27% of men and 14% of women reported their usual alcohol consumption as being more than the weekly recommended limit of 21 and 14 units per week respectively. Whilst these percentages are seen as encouraging when considered in the context of national targets - particularly in relation to reported consumption behaviours by men - the survey emphasises that ongoing harm prevention work should continue to be a priority, particularly in relation to women. This target was replaced in the Draft Budget 2005-06 with a new target: "Reduce the mortality rates for those aged under 75, between 1995 and 2010 by health improvement action to tackle diet, physical activity, smoking and alcohol consumption, by action to ensure early detection and improved access to treatment and care. We will reduce deaths due to cancer by 20%; coronary heart disease by 60%; and stroke by 50% by 2010." |
Target 6
(MET) | Ensure access to a GP, nurse or other healthcare professional within 48 hours by April 2004. |
Through central monitoring of this target, NHS Boards reported that 99.8% of practices demonstrated compliance with the SE Health Department's requirements in 2005-06. Similarly high levels of achievement (99.4%) were reported through the Quality and Outcomes Framework ( QOF) for 2005-06. |
Target 7
(MET) | No patient should wait longer than 26 weeks for a new outpatient appointment by the end of 2005. |
On 31 December 2005, only two patients without an Availability Status Code had been waiting more than 26 weeks for a first outpatient appointment. This compares with 42,000 patients waiting more the 26 weeks on 31 December 2004. These two breaches must however be put into context with NHSScotland undertaking over 4 million outpatient attendances each year. On 31 March 2006 (latest figures), no patient without an Availability Status Code had been waiting more than 26 weeks for a first outpatient appointment. To support NHSScotland deliver the 26 week target, the Centre for Change and Innovation's Outpatient Programme supported the development of 40 General Practitioners with a Specialised Interest ( GPwSI) in several specialties with particular pressures, as well as a number of specialist practitioner nurses and Allied Health Professionals who provide services in non-hospital settings. The programme also introduced Patient Focussed Booking into every hospital across Scotland as well focussing on the redesign of services. NHSScotland is now working to deliver an 18 week target by 31 December 2007 and excellent progress is being made. On 31 March 2006, just over 13,000 patients with an Availability Status Code had been waiting more than 18 weeks (but less than 26 weeks) for a first outpatient appointment. This is a reduction of nearly 30,000 (69%) on the position on 31 March 2005. This target was replaced in the Draft Budget 2005-06 with a new target: "By December 2007, we will have delivered a further reduction to the current guaranteed maximum waiting time of 6 months for inpatient treatment and 6 months for a first outpatient consultation; and improved diagnostic services through further investment and significantly shortened waiting times, against targets to be set in spring 2005." |
Target 8
(NOT MET) | No patient should wait longer than 2 months from urgent referral to treatment for all cancer cases by the end of 2005. |
Ministers agreed on a 95% target to allow for appropriate clinical exceptions. The Executive is pushing NHS Boards hard to achieve this target. We anticipate progress will continue to improve over time. In the period of January to March 2006, validated performance is expected to be c.78% (up from 74% in October to December 2005). We will move to weekly monitoring by the end October, including alerts to ensure proactive response to avoid unnecessary breaches. This target was replaced in the Draft Budget 2005-06 with a new target: "To work with NHS Quality Improvement Scotland, patients and clinicians to set new maximum condition specific waiting time guarantees by spring 2005. |
Target 9
(MET) | No patient should wait more than six months from diagnosis for inpatient treatment by the end of 2005. |
On 31 December 2005, only two patients with a guarantee had been waiting more than six months for inpatient or day case treatment and on 31 March 2006 (latest figures), no patient with a guarantee had been waiting more than six months. This compares with over 6,000 on 31 December 2004 and over 1,500 on 31 March 2005. These improvements have been made by providing significant investment in NHSScotland capacity and staffing. An important role has also be made by Golden Jubilee National Hospital which the Executive purchased in June 2002. Our expansion plans for the hospital has seen its activity increase from 2,500 procedures at time of purchase to over 28,000 procedures in 2005-06. Although Scotland's independent healthcare sector is small, we are making increasing use of independent providers on a basis which is fair and which offers a real increase in capacity. NHSScotland is now working to deliver an 18 week target by 31 December 2007 and excellent progress is being made. On 31 March 2006 (latest figures) over 6,000 patients with a guarantee had been waiting more than 18 weeks (but less than 26 weeks) for inpatient and day case treatment. This is a reduction of over 5,000 (46%) on the position on 31 March 2005. This target was replaced in the Draft Budget 2005-06 with a new target: "By December 2007, we will have delivered a further reduction to the current guaranteed maximum waiting time of 6 months for inpatient treatment and 6 months for a first outpatient consultation; and improved diagnostic services through further investment and significantly shortened waiting times, against targets to be set in spring 2005." |
Target 10
(ONGOING) | Bring 12,000 nurses and midwives into the NHS by 2007. |
The latest available published data at 30 September 2005, shows that we have brought 11,504 nurses and midwives into NHSScotland from the baseline date of September 2002. We remain on track to achieve and surpass this recruitment target by September 2007. |
Target 11
(MET) | Develop a national framework for improving the quality of clinical care by April 2004. |
NHS Quality Improvement Scotland ( NHSQIS) published draft standards for healthcare governance in January 2004 to promote improved safety and quality of care in the NHS in Scotland. This target was replaced in the Draft Budget 2005-06 with a new target: "All NHS Boards will demonstrate regular and sustained improvement, as reflected in the reports by NHS Quality Improvement Scotland ( QIS) in performance against the Healthcare Governance standards set by NHSQIS." The new target, set in Spending Review 2004 (above), is also one of the key targets which has been set for NHS Board Local delivery Plans. An interim review of clinical governance and risk management arrangements in the NHS to measure progress in improving clinical governance and the quality of care was published in June 2005, and new standards for clinical governance and risk management came into effect from November 2005. |
Target 12
(ONGOING) | 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. |
Hospitals have made significant progress towards the NHSQIS (formerly Clinical Standards Board for Scotland) standards on infection control and clean hospitals. Submissions from NHS Boards demonstrate that the majority of infection control standards have been met or partially met and that NHS Boards have work in hand to address any outstanding issues. Compliance with cleaning standards will now be measured using the tool developed to monitor compliance with the NHSScotland National Cleaning Services Specification. This has been rolled out to all NHS Boards, which began collecting data in April 2006. This tool will provide a mechanism locally for the identification and speedy rectification of cleaning issues; and will produce a quarterly report on compliance with cleaning requirements within NHS Boards. The first report will be published in September 2006. This target was replaced in the Draft Budget 2005-06 with a new target: "All NHS Boards will demonstrate regular and sustained improvement, as reflected in the reports by NHS Quality Improvement Scotland ( QIS) in performance against the Healthcare Governance standards set by NHSQIS." |
Target 13
(MET) | Progressively enable a greater number of older people to live and be cared for in their own homes in each year to March 2006. |
The number of older people receiving care at home of more than 10 hours per week has steadily increased from 10,807 at 31 March 2002 to 14,180 at 31 March 2005. The number of people receiving free personal care services at home has increased from 24,161 (receiving 167,124 hours) at July 2002 to 40,839 (265,361 hours) at September 2005. This target was replaced in the Draft Budget 2005-06 with a new target: "By 2008, increase the number of older people receiving intensive home care to 30% of all older people receiving long term care." |
Target 14
(MET) | Ensure by 2005 that all those with unmet need for free personal care are identified and receive the services they need. |
The number of people receiving free personal care services at home has increased from 24,161 (receiving 167,124 hours) at July 2002 to 40,839 (265,361 hours) as at September 2005. The replacement target below is designed to enable more older people to live and be cared for in their own homes. This target was replaced in the Draft Budget 2005-06 with a new target: "By 2008, increase the number of older people receiving intensive home care to 30% of all older people receiving long term care." |