Health and Sport Committee NHS Board Accounts 2013-14 Questionnaire Response from NHS Borders Service development 1. Please give THREE examples of service developments that: (a) you have been able to fund in 2013-14 (please list local service developments, rather than national programmes) NHS Borders is investing in the recurring running costs of a new palliative care unit The introduction of a proteinuria screening and treatment service The appointment of an additional consultant neurologist linked to increasing service demand (b) you would like to develop if you had additional funding i.e. what is next on your list of priorities? A full review of the cost and service pressures across the organisation was undertaken by NHS Borders and a list of areas to be supported in 2013/14 was presented to NHS Borders Strategy Group. All of the recommended priorities were funded. (c) you have withdrawn in 2013-14 (and why?). NHS Borders is not planning the withdrawal any services in 2013-14 Preventative spending 2. What specific preventative health programmes are included in budget plans for 2013-14? (please give details of planned expenditure in 2013-14 compared with 2012-13.) The table below provides some specific examples of preventative health programmes. 2012/13 2013/14 Tobacco Prevention Programme 202,000 263,000 Child Health Weight 55,000 55,000 Maternity Care (includes BFI) 32,000 32,000 1
Maternal & Infant Nutrition 49,000 49,000 Healthy Living Network 165,000 165,000 Keep Well 123,000 123,000 Learning Disability Sexual Health 13,000 11,000 Learning Disability Healthy Weight 11,000 10,000 Mental Health Improvement 10,000 10,000 National Immunisation Programme 267,000 375,000 Childsmile 291,000 291,000 Screening Programmes, Cytology, Retinopathy & Aortic Aneurysm 126,000 219,000 Detect Cancer Early 105,000 210,000 Infection Control 40,000 40,000 Drug and Alcohol 1,343,000 1,343,000 Blood Bourne Virus 187,000 187,000 3. Have you made any assessment of the potential longer term savings from preventative spending? If so, please describe your approach to this modelling. NHS Borders is currently considering how to identify longer term savings sufficiently robustly for them to be included in financial planning. Our initial thoughts are that this work would be best developed on a national basis, possibly through the Scottish Public Health Network or some other appropriate collaboration. However, the criteria for the introduction of preventative initiatives are that they will ultimately reduce the level of mortality and morbidity of the Border s population in future years. 4. How the results of any such modelling are reflected in your financial planning? NHS Borders has no robust methodology for identifying longer term savings which are a direct result of preventative spending therefore they are not reflected in our financial plan. 2
Access to new medicines 5. In relation to spending on newly-licenced medicines (whether or not approved by the SMC), please complete the table below: Please note there is no accepted definition of a newly licensed medicine. For this exercise we have looked at medicines reviewed by or due to be reviewed by Scottish Medicines Consortium (SMC) in 2011/12, 2012/13 and 2013/14, based on the Forward Look reports published by the SMC. The information provided relates to medicines considered by SMC as having a moderate to high net impact on the drugs budget. The expenditure provided relates to all uses of the drug not just the newlylicensed indication as this information is not recorded electronically. GP prescribing Hospital prescribing 2012-13 (planned) 41,000 588,000 2012-13 (actual) 24,000(to Feb 2013) 716,000 2013-14 (planned) 110,000 604,000 6. For each individual patient request agreed in 2012-13 (relating to newlylicenced medicines not recommended by the SMC), please complete the table below (please delete the example provided): Request number Actual cost Planned cost Medicine Therapy area 2012-13 2013-14 Deferasirox Iron overload 1,700 Nil Reducing inequalities 7. (a) What specific services are aimed at reducing inequalities? (please include details of Keep Well.) Keep well the service works mainly in primary care and assesses cardio vascular disease (CVD) in deprived areas. Health Living Network Borders Healthy Living Network (HLN) operates in five areas of high deprivation in Scottish Borders. HLN uses community development and assets based approaches to identify local priorities for health improvement and develop ways to address them. Sure Start Midwives the Early Years Assessment Team is an integrated team who work with pregnant women referred by Community Midwives 3
or by services such as Borders Addiction Service or Adult Mental Health Services. Immunisation Programme programmes include childhood vaccinations, HPV and flu. New programmes in 2013/14 will include rotavirus, zoster (shingles), Men c and childhood flu vaccines. Blood Borne Virus testing for hepatitis B/C and HIV in intravenous drugs users and the provision of a needle exchange service Screening Programmes including the following forms of screening - cervical, breast and colorectal cancer, diabetic retinopathy, pregnancy and newborn and aortic aneurysm Detect Cancer Early a local programme focused on increasing the awareness of cancer symptoms (b) What is the level of spending on these services in 2012-13 and 2013-14? Keep well 2012/13-123,000 2013/14-123,000 Healthy Living Network 2012/13-165,000 2013/14-165,000 Sure Start Midwives 2012/13-84,000 2013/14-84,000 Immunisation Programme 2012/13-267,000 2013/14-375,000 Blood Borne Virus 2012/13-187,000 2013/14-187,000 Screening Programmes 2012/13-126,000 4
2013/14-219,000 Detect Cancer Early 2012/13-105,000 2013/14-210,000 (c) What outcome measures have been identified for these services? Keep Well: Number of people who attend appointments Number of first health checks undertaken for carers Number of those attending for a health check with an ASSIGN risk score 20% Healthy Living Networks: Registration for community health programmes Recruitment of community health volunteers Sure Start Midwives Breastfeeding rates Early identification of additional need and risk in pregnancy Immunisation Programme Uptake figures Blood Borne Virus Uptake of tests Treatment numbers Needle return/ uptake of new needles Screening Programmes Uptake figures Detect Cancer Early Number of stage one cancer diagnosed (d) What information is available in relation to these outcomes? 5
Keep well People who attended appointments First health checks undertaken for carers Attending for a health check with an ASSIGN risk score 20% Healthy Living Networks Registrations for community health programmes Community health volunteers Sure Start Midwives Breastfeeding rates on leaving hospital Age profile of children presented to the Permanence Panel Immunisation Programme Flu vaccine uptake in over 65 s Flu vaccine uptake in under 65 s at risk Blood Borne Virus Dry blood spot tests numbers Patients treated for Hepatitis C New needles distributed annually Screening Programmes Breast screening uptake Cervical screening uptake Colorectal screening uptake Diabetic Retinopathy screening uptake Aortic aneurysm screening uptake Detect Cancer Early 2011 baseline information 6
Resource transfer 8. (a) What level of funding will be transferred from your budget to local authorities in 2013-14 (i.e. resource transfer) and what services will these funds help deliver? Resource Transfer 2013/14 Learning Disability Services 903,000 Infrastructure Costs 38,000 Mental Health 72,000 Elderly Residential 1,328,000 Children Services 101,000 Preserved Rights for Learning Disability 73,000 Total 2,515,000 (b) What level of funding will be transferred to your budget from local authorities in 2013-14 and what services will these funds help deliver? Funding transfer between partners organisation for 2013/14 has not yet been finalised. Examples of this in 2012/13 were discharge planning and children s services. NHS Borders and Scottish Borders Council have a joint learning disability service and a mental health and wellbeing partnership. Equalities 9. Can you provide any specific examples of how consideration of equalities issues has influenced budget decisions? An equality impact assessment of NHS Borders Local Delivery Plan is currently being carried out. Where gaps in access or provision of health services have been identified spending has been redirected to specific work streams. Examples: Sexual health project enabling patients with learning disabilities to access information and services. Health improvement work in areas where significant health inequalities have been identified. Funding for Keep Well project (migrant populations, gypsy travellers etc) to enable access to health checks. 7
Partner Funding for Pathway project (Violence against Women gender inequality). Sustainable development 10. Can you provide any specific examples of how the NHSScotland sustainable development strategy has influenced budget decisions? The Board currently has an annual energy spend of almost 2m and a carbon footprint of 10,604 tonnes of CO2. In meeting proposed targets, NHS Borders will save 1.8m and avoid emissions of 7,396 tonnes of CO2 in total over an 8 year period. Examples of schemes to achieve this are: The installation of biomass boilers to reduce CO 2 emissions and to provide fuel security at sites. An energy audit of the complete property portfolio in order to adjust heating times and temperatures to provide optimal efficiency and a reduction in carbon emissions. 8