For more information:www.rcn.org.uk/scotland
REPORT ON NHS
BOARDS’ SURVEY ON BUDGET PLANS
The Royal College of Nursing (RCN) Scotland hasbeen monitoring the fourteen NHS territorialboard
financial plans and performance for thelast three years, beginning with the datapresented in
Taking the Pulse of NHS Scotland
.Financial pressures are clearly impacting onpatient services and staff locally. As both aprofessional body and trade union, the RCN hascommitted to monitoring NHS territorial boardbudgets to help us engage with employers, theScottish Government, MSPs and our members inan informed, constructive and timely manner.This briefing sets out some of the issues emergingfrom our ongoing analysis that may be useful for
the Health and Sport Committee’s meeting on 1
Comparability and variation
Similar to the experience of the Health Committeewhen surveying health boards, we have found itdifficult to source reliable and comparable data tohelp us understand local pressures and the impactof variations in approach and performancebetween boards. Whilst the annual Audit Scotlandperformance review of the NHS
is an importantsource of audited finance data, it is published
nine months after year-end. We arealso interested in understanding and comparingperformance against plans at a time when we canwork to negotiate positive change for patients andour members.Our regular review of financial plans and activityacross the territorial boards is based on thefinancial annex to the Local Delivery Plan and thefinancial Monthly Monitoring Returns supplied byboards to Scottish Government. We obtain thesedocuments by regular Freedom of Informationrequests to boards. Whilst, if taken in isolation,these cannot provide us with answers to all ourquestions, they do provide the only top linecomparable finance information on key areas ofin-year expenditure and savings delivery that wehave been able to source.
As highlighted repeatedly by the RCN and others,there is still no means for us to verify that the
totality of “savings” planned and made are indeed
true cash efficiencies (providing the same orgreater service for less money), rather thanstraightforward service cuts. Our commentsbelow are made in this context.
We would urge a particular note of caution onthe possible interpretation of the statement onpage 16 of the report on the health boardsurveys
that: “it is notable that pay pressures are
not a factor that boards place in the top three[risks to the financial plan for 2012-
whilst the public sector pay freeze is in placeand workforce numbers continue to drop (withnursing numbers now lower than at any timesince 2006) pay may not be highlighted as aparticular budgetary pressure. However, in
responding to the Committee’s survey, twelve of
the fourteen territorial boards list concerns aboutmeeting their efficiency plans during 2012-13 intheir top three financial risks.Pay remains the largest single outlay of anyboard
and it is our understanding that boardsare still intending to reduce their pay bill in orderto make the efficiencies required for financialbalance
. As such, many of the savings boardsare planning
and which nearly all say are asignificant risk to meeting their financial plan
are likely to affect the workforce and pay costs.
(including Agenda forChange incremental increases) may not be asignificant pressure in the way that prescribingcosts are, but the drive to instigate
reductions to the pay bill
to break even through savings, is avery real pressure on boards, on staff and on thequality of services.Even in formal returns made to the ScottishGovernment, the impact of savings plans on theworkforce is not always clear. We believe that
the Scottish Government’s categorisation of
efficiency saving schemes is interpretedvariously across the territorial boards,particularly with regard to savings under the
“workforce” and “clinical productivity” headings.
The Scottish Government Local Delivery Plansand financial monitoring returns now requireboards to report savings plans and performanceagainst broad headings alone, and not onindividual savings plans. However, in previousdetailed iterations, it was clear that many
“clinical productivity” saving schemes included
significant reductions to workforce costs by, forexample, changing skill mix to deliver services.