We are responsible for managing and allocating public money to NHSScotland. We support Ministers in accounting to the public and the Scottish Parliament and set the strategic direction for NHSScotland.
We work to ensure that healthcare standards are met.
Actions
Specifically we are:
- providing guidance on the organisational duty of candour procedure for health, care or social work services
- working to improve waiting times for patients
- working to reduce the number of delayed discharges - people waiting to move from hospital wards to more appropriate settings
- working to improve unplanned (unscheduled) healthcare
- supporting the development of digital health and care through eHealth
- working to establish a Patient Safety Commissioner for Scotland
- working with experts to tackle antimicrobial resistance (AMR)
We also:
- review NHSScotland assets and control of capital expenditure
- produce consolidated financial reports summarising the monthly financial position for NHS Scotland
- confirm annually that health board Annual Operational Plans (AOPs) form a satisfactory basis on which to hold the Board to account for their contribution over the year
- provide guidance to NHS Boards on local delivery plans (LDPs) – the delivery contract between Scottish Government and NHS Boards in Scotland
- maintain data on NHS Scotland performance against LDP standards – agreed priorities between the Scottish Government and NHS Boards to provide assurance on NHS Scotland performance
- regularly assess NHS board performance against the standards and provide further scrutiny and support through the operation of our NHS Board Performance Escalation Framework
- published our healthcare waiting times improvement plan (October 2018)
- published the charter of patient rights and responsibilities in June 2019
- reviewed health and social care service resilience over public holidays in 2017
- published our eHealth Strategy 2014-2017 and our national action plan for technology enabled care in 2016
- worked in partnership with NHSScotland to develop the Scottish Patient Safety Programme and the Acute Adult programme to work on reducing harm
Background
Quality strategy
We published our Healthcare Quality Strategy for NHSScotland in May 2010 which set the approach and shared focus for achieving the 2020 vision for health and social care.
This strategy identified the following priorities:
- caring and compassionate staff and services
- clear communication and explanation about conditions and treatment
- effective collaboration between clinicians, patients and others
- a clean and safe care environment
- continuity of care
- clinical excellence
We established Healthcare Improvement Scotland in 2011 to take forward our healthcare priorities – particularly those of the Quality Strategy and the 2020 Vision. Its functions include:
- delivering improvement support
- quality assurance (through inspections and reviews)
- supporting the engagement of people and communities
- providing evidence include advice, standards and guidelines
More information is on the Healthcare Improvement Scotland website.
Budgets
In 2018-2019 the resource budget is £13.1 billion. This represents an increase of over £400 million from 2017-18 (3.4% uplift). As part of the budget approved by the Scottish Parliament, the 14 Territorial and 8 National Boards account for £10.9 billion of that spend, with the remainder administered directly by the Scottish Government. The NHS Board resource budget covers spending on operating costs such as pay, drugs and supplies.
In addition to the Budgets allocated at the outset of the year to NHS Boards, £2.2 billion is managed centrally by our Health and Social Care Directorates. The majority of this is allocated to NHS Boards over the course of the year. This includes total funding of £1.5 billion for the four professional groups of independent sub-contractors - medicine, pharmacy, dentistry and optometry, and also £303 million to support investment in reform.
The capital budget is £351 million in 2018-2019 and funds investment in the NHS estate, equipment and maintenance.
Performance
We published our health and social care delivery plan in December 2016. This set out the framework and actions needed to ensure that health and social care services are fit to meet requirements.
This was followed with a performance framework against which progress would be revised.
A report of an independent review of targets and indicators for health and social care was published in November 2017. This recommended that we move to a system of indicators and targets which allows tracking of improvements across a whole system of care.
Patient Safety Commissioner (PSC) for Scotland
First Do No Harm: The Report of the Independent Medicines and Medical Devices Safety Review (the Cumberlege Review) was published on 8 July 2020. The review examined how the healthcare system in England responds to reports about harmful side effects from medicines and medical devices, and made recommendations on how to respond to them more quickly and effectively in the future.
A key recommendation within the report is:
Recommendation 2: The appointment of a Patient Safety Commissioner who would be an independent public leader with a statutory responsibility. The Commissioner would champion the value of listening to patients and promoting users’ perspectives in seeking improvements to patient safety around the use of medicines and medical devices.
We first committed to the creation of a Patient Safety Commissioner role in Scotland in the 2020-21 Programme for Government. A debate was held in the Scottish Parliament on 8 September 2020, where Jeane Freeman MSP, then Cabinet Secretary for Health and Sport, reaffirmed this commitment, as well as accepting all of the other recommendations made within the Cumberlege Review. We produced a delivery plan for the implementation of the recommendations of the Review in March 2021.
The PSC Patient Reference Group was formed in October 2020 to advise on the development of proposals for the appointment of a PSC for Scotland.
The PSC Specialist Reference Group was formed in November 2020 to map the current patient safety landscape and to advise on whether any of the proposals put forward from the PSC Patient Reference Group duplicate or cross-over with existing processes and structures.
These groups helped to produce a public consultation on the proposals. An analysis of the responses was published in December 2021.
The PSC Bill Advisory Group was formed in July 2022 to give input into the detail of the proposals, including impact assessments, and following this and other stakeholder engagement a Bill to establish the role as an independent Parliamentary Commissioner was introduced to the Scottish Parliament in October 2022.
Bills and legislation
Patient Safety Commissioner for Scotland Bill
The Bill aims to establish a parliamentary commissioner, independent of the NHS and government, who will:
- advocate for systemic improvement in the safety of health care (which includes forensic medical examinations) in Scotland, and
- promote the importance of the views of patients and other members of the public in relation to the safety of health care
Further information can be found at on the Scottish Parliament website.
Patient rights
The Patient Rights (Scotland) Act 2011 aims to improve patients' experiences of using health services and to support people to become more involved in their health and health care.
The Act gives everyone the right to receive healthcare that:
- considers their needs
- considers what would most benefit their health and wellbeing
- encourages them to take part in decisions about their health and wellbeing, and gives them the information and support to do so
It also gives patients a right to give feedback (both positive and negative) or comments, and raise concerns or complaints, about the care they have received. The Act also requires that health boards encourage, monitor and learn from the feedback and complaints they receive.
The Act also establishes and provides access for patients and members of the public to the independent Patient Advice and Support Service (PASS) which provides information and helps raise awareness and understanding of their rights and responsibilities when using health services.
The Schedule to the Act includes a set of healthcare principles that must be taken account of when providing services.
The Act provided for the introduction of:
- the charter of patient rights and responsibilities in 2012 (revised 2019) – a summary of the rights and responsibilities that patients have when using NHS services in Scotland
- the 12 Week Treatment Time Guarantee Regulations 2012 - whereby eligible patients who are receiving planned treatment provided on an inpatient or day-case basis will not wait longer than 12 weeks from the date that the treatment is agreed to the start of that treatment
Action to deliver the rights and principles should be proportionate and appropriate to the circumstances and should balance the rights of individual patients with the effects on the rights of other patients. It should also take into account resources available and the responsibility of the health board to use resources efficiently and effectively.
More information on the development of the Act is in our website archive.
Duty of candour
The organisational duty of candour provisions of the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 (The Act) and The Duty of Candour Procedure (Scotland) Regulations 2018 set out the procedure that organisations providing health services, care services and social work services in Scotland are required by law to follow when there has been an unintended or unexpected incident that results in death or harm (or additional treatment is required to prevent injury that would result in death or harm).
Contact
Email: Central Enquiries Unit ceu@gov.scot
Telephone: 0300 244 4000