www.parliament.uk/commons-library | intranet.parliament.uk/commons-library | papers@parliament.uk | @commonslibrary

BRIEFING PAPER

Number 7533, 15 March 2016

NHS Scotland Statistics By Alex Bate

Inside: 1. The NHS in Scotland 2. Accident & Emergency 3. Ambulance Performance 4. Treatment Waiting Times 5. Cancer Waiting Times 6. Mental Health Waiting Times 7. Diagnostic Waiting Times 8. Workforce 9. Bed Occupancy 10. Delayed Discharges 11. Healthcare Associated

Infections 12. Expenditure

Number 7533, 15 March 2016 2

Contents Summary 3

1. The NHS in Scotland 4

2. Accident & Emergency 6

3. Ambulance Performance 8

4. Treatment Waiting Times 10

5. Cancer Waiting Times 12

6. Mental Health Waiting Times 14

7. Diagnostic Waiting Times 16

8. Workforce 17

9. Bed Occupancy 18

10. Delayed Discharges 19

11. Healthcare Associated Infections 21 11.1 Clostrium Difficile 21 11.2 Staphylococcus Aureus Bacteraemia (Including MRSA) 22

12. Expenditure 24

Cover page image copyright: Scottish Ambulance Service Volkswagen Crafter Emergency Ambulance by Tayside emergency vehicles. Licensed under CC BY-NC-SA 2.0 / image cropped.

3 NHS Scotland Statistics

Summary Health is a devolved policy area in Scotland, and the Scottish NHS differs in many regards from the NHS in other parts of the UK, in terms of structure, policy and performance. This briefing paper looks at statistics, key trends, and, where possible, comparison with other parts of the UK in the following areas of the NHS in Scotland:

Key statistics:

Accident & Emergency The NHS in Scotland has a target that 95% of patients should spend under four hours in A&E from arrival to admission, transfer or discharge. For 2015, 93.3% of patients waited under four hours. Ambulance Performance The target that 75% of Category A calls should have an ambulance on the scene within 8 minutes was not met for 2014/15 – 72.2% of calls were reached in the target time. Treatment Waiting Times NHS Scotland has not met its target of 90% of patient referral-to-treatment journeys completed in 18 weeks since June 2014. Diagnostic Waiting Times A higher percentage of patients wait over 6 weeks for MRI and CT scans in Scotland than England. Cancer Waiting Times NHS Scotland’s 95% 31 day target from decision to treat to first cancer treatment has been consistently met in recent years, whilst its 95% 62 day target from urgent referral to treatment has not been met since 2012. Mental Health Waiting Times There are significant variations in mental health waiting times by regional health board. For child and adolescent mental health waiting times, these differences are even more pronounced Workforce Scotland has more GPs per head of population (8.1) than the other UK nations. Bed Occupancy NHS bed occupancy in Scotland has consistently been between 3 and 5 percentage points lower than in England Delayed Discharges The number of delayed discharge days has risen in recent years, although the proportion of these days experienced by patients aged over 75 has fallen from 75% to 70% since 2012. Healthcare Associated Infections Although NHS Scotland has not yet met its target for SAB cases, the number of MRSA cases has fallen by 88% between 2006 and 2014, from 274 to 32. Expenditure Health expenditure per head in Scotland for 2013/14 was the highest of the four UK nations at £2,151. Health expenditure per head in Wales has risen by 6% in real terms since 2009/10.

Number 7533, 15 March 2016 4

1. The NHS in Scotland Responsibility for the NHS in Scotland has been devolved to the Scottish Government since 1999. A key difference between NHS Scotland and NHS England is the absence of a ‘purchaser-provider split’ – in Scotland, 14 regional NHS boards are responsible for both funding and provision of NHS services (see Figure 1), as well as 8 special NHS boards:

• NHS Education for Scotland (training and education for NHS Scotland workforce)

• NHS Health Scotland (promoting ways to improve the health of the population and reduce health inequalities)

• NHS National Waiting Times Centre

• NHS24 (Health advice and information)

• Scottish Ambulance Service

• The State Hospitals Board for Scotland (providing assessment, treatment and care in conditions of special security for individuals with a mental disorder whom because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting)

• NHS National Services Scotland (services including health protection, blood transfusion and information)

• Healthcare Improvement Scotland: (improvement of healthcare provision and scrutiny of services)1

Figure 1: Map of regional NHS boards in Scotland

Source: Scottish Government

1 The Scottish Government, NHS Boards, (last accessed 15 March 2016)

5 NHS Scotland Statistics

In some cases, meaningful statistical comparisons between NHS Scotland and NHS England are not possible because of differences in targets, definitions and data collection.

Even where comparisons are possible, it is important to bear in mind that there are other differences between the two health systems. Given the different population profiles of England and Scotland, the Nuffield Trust argued that the North East of England was a better comparator for Scotland than England as a whole.2

Additional statistics to those presented here can be found on the Information Services Division (ISD Scotland) website.

2 Nuffield Trust/ Health Foundation, The four health systems of the United Kingdom:

how do they compare?, 2014

Number 7533, 15 March 2016 6

2. Accident & Emergency Each month, around 130,000 to 140,000 patients attend A&E in Scotland. Since 2009/10, there has been a target to reduce the attendance rate at Emergency Departments (EDs)3 to 2,095 per 100,000 population by March 2014. As of June 2014, the rate was 2,237 per 100,000.

As shown in Chart 1 (right) however, the proportion of A&E attendances in EDs has fallen from 88% in the year to June 2008, to 82% in the year to January 2016. Over the same period, the number of attendances at other, non-emergency A&E departments (including, for example, Minor Injuries Units) has risen by 49%.

NHS Scotland has a target that 95% of patients attending A&E will wait fewer than four hours until they are admitted, transferred or discharged. This is the same target as in England, which allows for some comparison of performance.

As Chart 2 shows, performance in England and Scotland followed similar highs and lows in performance. Until recently, England saw a higher percentage of patients within four hours, although since July 2015, Scotland has performed better on this measure.

Between July and September 2015 the 95% target in Scotland was met the first time since August 2013. The target has not been met from October 2015 onwards.

Chart 2: Percentage of patients waiting under 4 hours in A&E

Table A shows the most recently monthly A&E performance by NHS regional board. Seven of the boards did not meet the 95% target, with three (Greater Glasgow & Clyde, Lanarkshire and Lothian) seeing under

3 Emergency Departments are A&E sites that provide a 24-hour consultant led service

Chart 1: A&E attendances by department type (12 month rolling average)

7 NHS Scotland Statistics

90% of patients within four hours. The best performing boards were Western Isles and Tayside, seeing 99.2% and 98.9% of patients within four hours respectively.

It is important to note the very large differences in number of A&E attendances between boards, ranging from 457 in Orkney to 33,413 in Glasgow & Greater Clyde. Better performance against the 95% measure tends to occur in boards with smaller number of attendances, although Tayside was the second best performing despite being the sixth busiest.

Table A: A&E performance by NHS regional board, January 2016

Source: ISD Scotland, Waiting Times – Emergency Departments; NHS England, A&E Attendances and Emergency Admissions

NHS Board

Ayrshire & Arran 90.9% 9,875

Borders 96.9% 2,099

Dumfries & Galloway 94.1% 4,022

Fife 94.1% 7,118

Forth Valley 93.4% 6,379

Grampian 96.3% 10,904

Greater Glasgow & Clyde 89.8% 33,413

Highland 96.2% 7,629

Lanarkshire 88.6% 16,079

Lothian 88.5% 21,894

Orkney 98.2% 457

Shetland 95.7% 607

Tayside 98.9% 8,425

Western Isles 99.2% 623

% waiting under 4 hours

Number of A&E attendances

Number 7533, 15 March 2016 8

3. Ambulance Performance The Scottish Ambulance Service has three main targets on how quickly it should respond to emergency calls:

• Reach 75% of Category A (life-threatening) emergency incidents within 8 minutes;

• Reach 95% of Category B (serious but not life-threatening) incidents within 19 minutes;

• Reach 80% of cardiac arrest patients within 8 minutes (mainland).

For 2014/15, 87.8% of Category B incidents were seen within 19 minutes, and 74.2% of mainland cardiac arrest patients were reached within 8 minutes.

Chart 3 shows the performance against the Category A target since its introduction in 2008/09. Note that prior to 2013/14, this target was for the Scottish mainland only, which could partially explain falling performance against the measure for the most recent two years.

Chart 3: Percentage of Category A calls reached within 8 minutes (mainland only prior to 2013/14)

Although NHS England also has a target of 75% of Category A calls to be reached within 8 minutes, this is not comparable with the Scottish figures. This is because of the different ways in which the clock start is defined.

England further divides Category A calls into Red 1 and Red 2. For Scotland, the 8 minutes starts when the chief complaint is established, for English Red 1 calls, the 8 minutes starts when the 999 call starts, and for English Red 2 calls, the 8 minutes starts when the chief complaint is obtained, the first vehicle is assigned or 60 seconds after call connect.4

4 NHS England, Ambulance Quality Indicators: Quality Statement, April 2015

9 NHS Scotland Statistics

The inclusion of the Scottish island boards in the Category A measure is a significant inclusion given the different challenges faced by these areas in terms of ambulance provision. Table B gives a clear indication of these challenges.

Table B: Percentage of A&E incidents which are air ambulance missions, 2014/15

The three island regional board areas all have at least 9% of all A&E incidents as air ambulance missions, whilst five of the eleven mainland board areas have a figure of less than 0.1%.

Source: Scottish Ambulance Service, Annual report (various years)

Ayrshire & Arran 0.2%

Borders 0.0%

Dumfries & Galloway 0.2%

Fife 0.0%

Forth Valley 0.0%

Grampian 0.4%

Greater Glasgow & Clyde 0.3%

Highland 2.6%

Lanarkshire 0.0%

Lothian 0.0%

Orkney 16.8%

Shetland 13.9%

Tayside 0.1%

Western Isles 9.2%

Number 7533, 15 March 2016 10

4. Treatment Waiting Times Throughout Scotland there are around 100,000 ‘completed patient journeys’ per month. A completed patient journey is the time between a patient coming into contact with the healthcare service (for example, seeing their GP) and receiving treatment.

There is a general referral-to-treatment (RTT) target that 90% of patients should commence treatment within 18 weeks of referral, from a GP or any other source. This is similar (but not identical, to the RTT target in England).

Within these 18 weeks of referral-to-treatment, there are two other targets for the different stages of the patient journey:

• 95% of patients should wait no longer than 12 weeks from referral to their first hospital outpatient appointment;

• 100% of patients should wait no longer than 12 weeks from agreeing to treatment (usually after an outpatient appointment) to treatment itself.

This second target, known as the Treatment Time Guarantee (TTG) is set out in legislation.5

Chart 4: Percentage of patients seen within 12 weeks, new outpatient and Treatment Time Guarantee (TTG) measures

As Chart 4 shows, although performance on the new outpatient appointment measure has been falling since 2009, this fall has accelerated since the introduction of the legally-backed TTG measure. In the 13 quarters since the TTG measure was introduced, performance against the new outpatient measure fell by almost 11 percentage points, whilst it fell less than 4 percentage points in the 13 quarters up to the introduction of the TTG.

5 Patient Rights (Scotland) Act 2011, sections 8-13

11 NHS Scotland Statistics

Note that the TTG measure is only for patients added to the waiting list after 1 October 2012, which explains the near 100% performance on this measure in the fourth quarter of 2012.

With regards to the RTT target, England also has an 18 week measure. However, the two countries are not directly comparable for the following reasons:

• In England the target is 92% of patients seen within 18 weeks, in Scotland the target is 95%;

• The English target is that 95% of patients on the waiting list for treatment will have been waiting for fewer than 18 weeks. In Scotland, the target is that 95% of patients that have received treatment did so within 18 weeks.

England used to have a target for completed patient journeys (known in England as completed pathways), but scrapped this as it was argued to penalise patients that had already waited over 18 weeks, with no incentive to then treat them.6

Despite this differences in methodology, which must be taken into account, since 2013 performance on the respective RTT measures have been consistently 3 to 4 per cent higher in England than in Scotland. As Chart 5 shows, Scotland has not met the RTT target since June 2014.

Chart 5: Percentage of patient journeys completed within 18 weeks

Source: ISD Scotland, Waiting Times; NHS England, Consultant-led Referral to Treatment Waiting Times

6 Letter from National Medical Director to Chief Executive, NHS England, 4 June 2015

Number 7533, 15 March 2016 12

5. Cancer Waiting Times The NHS in Scotland has two major cancer waiting times targets. These are 95% of all patients diagnosed with cancer to begin treatment within 31 days of decision to treat, and 95% of those referred urgently with a suspicion of cancer to begin treatment within 62 days of referral.

Chart 6: Percentage of patients waiting fewer than 31 days from decision to treat until first cancer treatment

England has a similar target for time from decision to treatment of 31 days, although its target is 96%. Performance on this measure is shown in Chart 6. Although England has slightly better performance on this measure, both England and Scotland have performed above their respective targets for each quarter over the period shown.

By contrast, performance on the 62 day measure has not met the 95% target since the fourth quarter of 2012 (see Chart 7). England collects similar data for urgent referrals to begin treatment within 62 days. However, these are not comparable for the following reasons:

• Urgent referral in Scotland refers to GP (or primary care) referral, self-referral or national screening programme referral. In England, urgent referral refers to GP referral, screening programme referral and consultant referral.

• In England, these three referral types are collected and presented separately, and have separate 62 day targets (85%, 90% and no target respectively).

13 NHS Scotland Statistics

Chart 7: Percentage of patients waiting fewer than 62 days from urgent referral to first cancer treatment

As shown in Table C, there is some variation on performance against both measures for different cancer sites. Whilst overall, and for most cancer sites, over 95% of patients wait fewer than 31 days from decision to treat until treatment, for urological cancers this is less than 90%.

In addition, whilst overall, fewer than 95% of patients wait under 62 days from urgent referral to first cancer treatment, 96% of melanoma patients and 98% of breast cancer patients wait fewer than 62 days.

Table C: Percentage of patients receiving cancer treatment within national standards, by cancer site, year to September 2015

Source: ISD Scotland, Waiting Times – Cancer; NHS England, Cancer Waiting Times

Breast 97.3% 98.0%

Cervical 97.0% 91.4%

Colorectal 97.8% 87.6%

Head & Neck 96.4% 85.0%

Lung 99.3% 94.0%

Lymphoma 99.4% 92.8%

Melanoma 98.0% 95.6%

Ovarian 98.2% 94.6%

Upper GI 98.7% 92.8%

Urology 89.4% 83.0%

31 day target 62 day target

Number 7533, 15 March 2016 14

6. Mental Health Waiting Times As part of what is known as improving access to psychological therapy (IAPT), the target for mental health waiting times in Scotland is that 90% of patients commence psychological therapy based treatment within 18 weeks of referral.

The equivalent target in England is that 95% of patients should begin therapy within 18 weeks. As Chart 8 shows, this higher target has been met in every month for which data is available in England, whilst the lower, 90% target, has not yet been met in Scotland.

Chart 8: Percentage of patients waiting under 18 weeks from referral to psychological therapy based treatment

In both England and Scotland however, access to psychological therapy in good time varies hugely by local area. Table D shows this variation across Scottish health boards. For IAPT statistics, the three island boards’ data is collected together to prevent disclosive numbers.

Table D: IAPT performance by NHS board, fourth quarter 2015

Total patients

seen

% waiting under 18

weeks

Ayrshire & Arran 1,767 76%

Borders 144 74%

Dumfries & Galloway 666 66%

Fife 1,268 71%

Forth Valley 634 83%

Grampian 853 71%

Greater Glasgow & Clyde 3,067 95%

Highland 359 96%

Lanarkshire 1,698 96%

Lothian 1,463 70%

Tayside 1,075 96%

Island Boards 132 86%

15 NHS Scotland Statistics

Unlike in England, Scotland also collects and publishes data on child and adolescent mental health services (CAMHS). This has the same performance target of 90% to commence treatment within 18 weeks of referral. As shown in Chart 9, the target has not been met since July 2014.

Chart 9: Percentage of children commencing mental health treatment within 18 weeks of referral

The regional disparities in terms of access to child and adolescent mental health services are even more pronounced than for adult psychological therapies. As Table E shows, for the most recent quarter, performance ranged from 100% of patients starting treatment within 18 weeks in Greater Glasgow & Clyde, to just 34% in Forth Valley.

Table E: Percentage of children commencing mental health treatment within 18 weeks of referral, fourth quarter 2015

Source: ISD Scotland, Waiting Times – Psychological Therapies, HSCIC, Improving Access to Psychological Therapies

Total patients

seen

% waiting under 18

weeks

Ayrshire & Arran 266 99%

Borders 182 76%

Dumfries & Galloway - 99%

Fife 379 81%

Forth Valley 352 34%

Grampian 278 50%

Greater Glasgow & Clyde 968 100%

Highland 163 97%

Lanarkshire 506 89%

Lothian 698 59%

Tayside 550 58%

Island Boards - 89%

Number 7533, 15 March 2016 16

7. Diagnostic Waiting Times Between 2013 and 2015, the average number of patients waiting for one of eight key diagnostic tests and interventions rose by 23%, from 47,000 to 57,000. The waiting times standard for these diagnostics is less than six weeks. As Table F shows, performance against this varies widely depending on which test is being measured.

Table F: Percentage of patients waiting over six weeks for diagnostic tests and interventions, 2015

Due to differences in categorisation and choice of tests on which to report data, it is not possible to compare England and Scotland on many of these key eight tests. Comparable data is available for CT and MRI scans. These are two of the better performing tests against the six week measure in Scotland, although compared to England, a higher proportion of patients experience long waits (see Charts 10a & 10b).

Charts 10a & 10b: Percentage of patients waiting over six weeks for CT and MRI scans

Source: ISD Scotland, Waiting Times – Diagnostics; NHS England, Diagnostics Waiting Times and Activity

8 Key Diagnostic Tests & Investigations 10%

Upper Endoscopy 24%

Lower Endoscopy (excl. Colonoscopy) 33%

Colonoscopy 21%

Cystoscopy 20%

All Endoscopy 23%

CT 3%

MRI 7%

Barium Studies 1%

Ultrasound 2%

All Radiology 4%

17 NHS Scotland Statistics

8. Workforce Table G shows key categories of the NHS Scotland workforce. The medical and dental categories exclude general and dental practitioners, and refer instead to doctors and dentists employed in hospitals and the community. Nursing and midwifery staff includes staff employed in hospitals and the community, as well as other locations of service delivery including prisons.

Since 2010, the number of whole time equivalent (WTE) medical staff has increased by 13%, and nursing and midwifery staff has increased slightly (by 2%). Of the categories below, the largest decreases have been in management grades (44%) and ambulance services (34%).

Table G: NHS Scotland workforce, key categories (WTE as of 30 September each year)

Table H shows the number of GPs per 10,000 population in UK countries since 2004. The number of GPs in Scotland is higher than that of the other UK countries, and has been over the entirety of the period shown.

Table H: GPs per 10,000 population in UK countries (Headcount as of 30 September each year)

Source: ISD Scotland, Workforce; StatsWales, UK comparisons of general practitioners workforce by year

Scotland England Wales N Ireland

2004 7.8 6.3 6.2 6.3

2005 7.9 6.5 6.3 6.3

2006 8.0 6.5 6.3 6.4

2007 8.2 6.5 6.5 6.4

2008 8.2 6.6 6.5 6.5

2009 8.2 7.0 6.5 6.5

2010 8.2 6.8 6.6 6.5

2011 8.1 6.8 6.6 6.1

2012 8.1 6.7 6.5 6.5

2013 8.0 6.6 6.6 6.4

2014 8.1 6.6 6.5 6.6

2010 2011 2012 2013 2014 2015% change

2010 - 2015

Medical 10,732 11,237 11,231 11,485 12,014 12,160 +13%

Dental 708 724 713 696 685 652 -8%

Nursing & Midwifery Staff 57,878 56,309 56,263 57,369 58,407 58,923 +2%

Ambulance Services 3,698 3,643 3,640 2,338 2,385 2,440 -34%

Management Grades 1,235 1,086 949 846 790 689 -44%

Number 7533, 15 March 2016 18

9. Bed Occupancy Over the past five years, from the third quarter of 2010 to the third quarter of 2015, the daily average number of available staffed beds has fallen by 10%, from around 21,000 to around 19,000.7 This trend should be interpreted in the context of a shift to increased care in the community (i.e. outside of hospitals).

Chart 11 compares bed occupancy for all specialties in England and Scotland. Both nations follow very similar trends on a quarter by quarter basis, although despite this, bed occupancy in Scotland has consistently been between 3 and 5 percentage points below bed occupancy in England.

Chart 11: Percentage occupancy of NHS beds (all specialties)

Source: ISD Scotland, Hospital Care; NHS England, Bed Availability and Occupancy

7 Due to data issues, Scotland figures for hospital beds exclude Grampian and

Highland NHS boards

19 NHS Scotland Statistics

10. Delayed Discharges NHS Scotland records data on delayed discharges from acute hospital settings, which is when a patient is ready and safe to leave but is unable to do so. This is different to delayed transfers of care, as recorded in England, which include delays for transfers within hospitals for further care. The two datasets are therefore not comparable.

Chart 12a shows that the total number of delayed discharge days has slightly increased overall since 2012, despite a fall of over 7,000 days in one month between January and February 2015.

Over the same time period, the proportion of delayed days experienced by patients over 75 has decreased from 75% to 70% (see Chart 12b). The days experienced by patients over 75 have still been increasing over the period, but at a slower rate than those for patients aged 18 to 75.

Charts 12a & 12b: Total delayed discharge days (thousands) and percentage of total days experienced by patients aged 75+

The average delayed discharge per patient was 42 days in 2013, which had reduced to 40 days for 2015. However, this is still some distance from the performance measures proposed by the Joint Improvement Team (JIT).8

These proposed that no delays of more than four weeks should take place after April 2013, and no delays of more than two weeks should take place after April 2015.

As Chart 13 shows, a significant proportion of standard delayed discharges (around 50%) are for longer than two weeks.

8 JIT is a partnership between the Scottish Government, NHS Scotland, Scottish local

authorities (COSLA) and the third, independent and housing sectors

Number 7533, 15 March 2016 20

Chart 13: Percentage of patients experiencing delayed discharges of over 2, 4 and 6 weeks

Around three quarters of total standard delays are a result of community care arrangements. Of these community care arrangement delays, around half are the result of patients waiting for a care home place or for care home funding.

Source: ISD Scotland, Health & Social Community Care - Delayed Discharges

21 NHS Scotland Statistics

11. Healthcare Associated Infections

Health Protection Scotland reports quarterly on a number of Healthcare Associated Infections (HAIs), including E Coli and Norovirus. Two HAIs, Clostrium Difficile and Staphylococcus Aureus Bacteria (SAB – which includes MRSA) have associated performance targets.

11.1 Clostrium Difficile For Clostrium Difficile infections, the Scottish Government has set a target of 32 cases or less per 100,000 occupied bed days in patients aged 15 or above.

As Chart 14 shows, this rate was first met in the first quarter of 2013, then in only one subsequent quarter (first quarter of 2014). The data is collected through sampling, and therefore the chart includes 95% confidence intervals. These show the upper and lower intervals, between which we can be 95% confident the figure given is not due to sampling error. Only in the first quarter of 2014 was the upper interval also below the target of 32 cases per 100,000 occupied bed days.

Chart 14: Rate of Clostrium Difficile cases per 100,000 occupied bed days (including upper and lower confidence intervals)

Rates of Clostrium Difficile cases in England per 100,000 bed days are given for those aged 2 or above, and so are not comparable with figures for Scotland.

Rates of Clostrium Difficile cases also vary by Scottish health boards. As Table I shows, for the year to September 2015, the national target was met by 5 out of 14 boards, the best performing of which were Borders and Forth Valley, with rates of 20 cases per 100,000 bed days. The worst performing board was Lothian, followed by Shetland and the Western Isles.

Number 7533, 15 March 2016 22

Table I: Rate of Clostrium Difficile cases per 100,000 occupied bed days, by regional NHS board

11.2 Staphylococcus Aureus Bacteraemia (Including MRSA)

The target for Staphylococcus Aureus Bacteraemia (SAB) cases is 24 cases or less per 100,000 bed days. SAB cases are categorised as either meticillin-resistant (MRSA) or meticillin-susceptible (MSSA). Given its resistance to a number of widely used antibiotics, MRSA outbreaks are usually more serious than MSSA.

As Chart 15 shows, although SAB case rates have been falling in recent years, the 24 cases target has not yet been met in any quarter. MRSA cases have also fallen significantly over the period. Between the first quarter of 2006 and the first quarter of 2014, the number of cases fell by 88%, from 274 to 32.

Chart 15: SAB cases per 100,000 occupied bed days (including upper and lower confidence intervals)

Ayrshire & Arran 39

Borders 20

Dumfries & Galloway 39

Fife 26

Forth Valley 20

Grampian 28

Greater Glasgow & Clyde 29

Highland 39

Lanarkshire 33

Lothian 42

Orkney 33

Shetland 41

Tayside 37

Western Isles 41

23 NHS Scotland Statistics

Chart 16 compares MRSA cases per 100,000 bed days in England and Scotland. As England only provides this data by year, whilst Scotland provides it by quarter, care should be taken not to compare individual points on the chart, as this may represent a particularly good or bad quarter rather than performance over the year as a whole.

Instead the chart gives a broad picture of trends in reduction of the number of MRSA cases. The chart shows significant reductions in case rates for both England and Scotland, with both nations now recording rates of around 2 or 3 cases per 100,000 bed days.

Chart 16: MRSA rates per 100,000 bed days in England (annual data) and Scotland (quarterly data)

Source: Health Protection Scotland, Clostrium Difficile infection quarterly report, Staphylococcus aureus Bacteraemias quarterly report; Public Health England, MRSA bacteraemia: annual data

Number 7533, 15 March 2016 24

12. Expenditure Chart 17 and Table J show total identifiable expenditure per head on health in Scotland, England, Wales, Northern Ireland, and the UK as a whole. North East England is included for comparison, as the Nuffield Trust argued that this was the closest English region to Scotland in terms of population characteristics (see section 1)

Scotland has had the highest expenditure on health per head of population of the four UK nations, in each year since 2009/10. Since 2012/13 however, the North East of England has had a higher expenditure per head. Since 2009/10 expenditure on health per head in Scotland has risen by 6% in real terms.

Chart 17: Total identifiable expenditure on health (£ per head), UK countries and regions (2013/14 prices)

Table J: Total identifiable expenditure on health

2009/10 2010/11 2011/12 2012/13 2013/14 2009/10 2010/11 2011/12 2012/13 2013/14

England 96,117 98,353 99,792 102,468 107,412 England 104,521 103,835 103,744 104,609 107,412Scotland 10,616 10,877 11,056 11,285 11,459 Scotland 11,544 11,483 11,494 11,521 11,459Wales 5,926 6,119 6,075 6,001 6,141 Wales 6,444 6,460 6,316 6,126 6,141N Ireland 3,442 3,595 3,638 3,844 3,882 N Ireland 3,743 3,795 3,782 3,924 3,882UK 116,100 118,945 120,561 123,597 128,894 UK 126,252 125,575 125,336 126,179 128,894

2009/10 2010/11 2011/12 2012/13 2013/14 2009/10 2010/11 2011/12 2012/13 2013/14

England 1,841 1,868 1,879 1,916 1,994 England 2,002 1,972 1,953 1,956 1,994Scotland 2,029 2,067 2,086 2,124 2,151 Scotland 2,206 2,182 2,169 2,168 2,151Wales 1,950 2,006 1,983 1,952 1,992 Wales 2,121 2,118 2,062 1,993 1,992N Ireland 1,919 1,992 2,005 2,108 2,121 N Ireland 2,087 2,103 2,084 2,152 2,121UK 1,865 1,895 1,905 1,940 2,011 UK 2,028 2,001 1,980 1,981 2,011

Cash Terms 2013/14 Prices

Total Identifiable Expenditure (£ million)

Expenditure per Head

(£)

25 NHS Scotland Statistics

Table K shows the expenditure per head of population by NHS regional board in 2014/15. The difference between the boards with the highest (Western Isles) and the lowest (Lanarkshire) spend amounted to £897 per person.

Table K: Expenditure by NHS regional board, 2014/15

Source: HM Treasury, Public Expenditure Statistical Analyses; ISD Scotland, Finance

Total expenditure (£000s)

Expenditure per person (£)

Ayrshire & Arran 701,842 1,891

Borders 193,467 1,697

Dumfries & Galloway 284,405 1,897

Fife 603,626 1,644

Forth Valley 505,300 1,682

Grampian 964,051 1,650

Greater Glasgow & Clyde 2,737,827 2,396

Highland 592,294 1,847

Lanarkshire 1,017,789 1,558

Lothian 1,578,489 1,840

Orkney 41,443 1,920

Shetland 44,778 1,928

Tayside 871,735 2,107

Western Isles 66,887 2,455

BRIEFING PAPER Number 7533, 15 March 2016

About the Library The House of Commons Library research service provides MPs and their staff with the impartial briefing and evidence base they need to do their work in scrutinising Government, proposing legislation, and supporting constituents.

As well as providing MPs with a confidential service we publish open briefing papers, which are available on the Parliament website.

Every effort is made to ensure that the information contained in these publically available research briefings is correct at the time of publication. Readers should be aware however that briefings are not necessarily updated or otherwise amended to reflect subsequent changes.

If you have any comments on our briefings please email papers@parliament.uk. Authors are available to discuss the content of this briefing only with Members and their staff.

If you have any general questions about the work of the House of Commons you can email hcinfo@parliament.uk.

Disclaimer This information is provided to Members of Parliament in support of their parliamentary duties. It is a general briefing only and should not be relied on as a substitute for specific advice. The House of Commons or the author(s) shall not be liable for any errors or omissions, or for any loss or damage of any kind arising from its use, and may remove, vary or amend any information at any time without prior notice.

The House of Commons accepts no responsibility for any references or links to, or the content of, information maintained by third parties. This information is provided subject to the conditions of the Open Parliament Licence.