Scottish Health Service Costs Year ended March 2020

Publication date: 23 February 2021

A National Statistics publication for Scotland Public Health Scotland

This is a National Statistics publication

National Statistics status means that the official statistics meet the highest standards of trustworthiness, quality and public value. They are identified by the quality mark shown above. They comply with the Code of Practice for statistics and are awarded National Statistics status following an assessment by the UK Statistics Authority’s regulatory arm. The Authority considers whether the statistics meet the highest standards of Code compliance, including the value they add to public decisions and debate. Find out more about the Code of Practice at: https://www.statisticsauthority.gov.uk/osr/code-of-practice/

Find out more about National Statistics at: https://www.statisticsauthority.gov.uk/national-statistician/types-of-official-statistics/

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Contents

Introduction ...... 3 Context of the Report ...... 5 Main Points ...... 6 Results and Commentary ...... 7 1 Total Operating Costs ...... 7 1.1 NHS Costs by Sector ...... 8 1.2 NHS Costs by Board ...... 10 2 Hospital Sector ...... 11 3 Community Sector ...... 14 4 Family Health Sector ...... 16 5 Staff Costs ...... 19 Glossary ...... 21 Contact ...... 22 Further Information ...... 22 Open data ...... 22 Rate this publication ...... 22 Appendices ...... 23 Appendix 1 – Background information ...... 23 Appendix 2 – Publication Metadata ...... 24 Appendix 3 – Early access details ...... 29 Appendix 4 – PHS and Official Statistics ...... 30

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Introduction

Scottish Health Service Costs (often referred to as the ‘Costs Book’) is published annually by Public Health Scotland (PHS), with the support of the Scottish Government Health and Social Directorates (SGHSCD) and the NHS Board Finance Departments. It provides the most comprehensive source of statistics on expenditure within NHS Scotland. The information contained within this report is used in many applications; for example, to ensure greater efficiency by allowing benchmarking comparisons to be made between health care providers. The data collection is currently structured to analyse around 95% of NHS Scotland’s net operating costs. This includes £13.2 billion of expenditure for the provision of secondary and primary care within the 14 territorial NHS Boards, the State Hospital and the National Waiting Times Centre (Golden Jubilee). In addition, information is provided for the Scottish Ambulance Service and National Services Scotland but is not included in the overall expenditure. There is no information included for NHS24, Public Health Scotland (PHS), Health Improvement Scotland (HIS) and National Education Scotland (NES). The Costs Book contains large amounts of data, ranging from National and NHS Board level summaries, to detailed information regarding individual hospitals and specialties. A range of tables provide information on the main expenditure areas and how these translate into the average cost of treating patients in various services. When making comparisons across Scotland, or interpreting the Costs Book data, it should be noted that individual NHS Boards/hospitals in rural settings, e.g. Island Boards can have a low volume of patients, but relatively high fixed costs, which can result in substantial fluctuations in unit costs for some hospitals. The information in the Costs Book is organised into hospital and primary care service categories. The primary care is further split into community sector and family sector. The range of services covered in each sector includes: Hospital sector – covering the cost of delivering services provided in hospitals. This ranges from the delivery of complex surgery within an inpatient setting within large teaching hospitals to outpatient clinics run at rural community hospitals. Community sector – covering services delivered out with a hospital setting but excluding those provided by independent contractors, providing ‘family health services’. Examples include home visits by healthcare professionals, such as health visitors, district nurses or occupational therapists, but also prevention services such as breast screening and health promotion. Family Health sector – services provided by the family doctor (GP) and the "High Street" dentists, opticians and pharmacists. Within the Cost Book, costs from 2019/20 are compared against those from previous years. Historic costs are shown both in ‘cash terms’ (which is the actual cost from each of the previous years) and in ‘real terms’ (where an adjustment factor, known as the ‘GDP deflator’ determined by HM Treasury, is applied to estimate the equivalent cost in 2019/20).

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Information contained in the Costs Book is primarily derived from Scottish Financial Returns (SFRs) which are compiled by NHS Boards, and completed as part of their annual accounts cycle. NHS Board annual accounts are audited by an independent body before being agreed by the Scottish Government. While there is no audit of the Costs Book, Boards are required to show how the costs included in the Costs Book reconcile to expenditure and income reported in the Statement of Comprehensive Net Expenditure (SOCNE) from the annual accounts. To support this process, the Scottish Government is responsible for providing NHS Boards with an Annual Accounts manual. PHS also issue data templates (SFR 29.0) to record this reconciliation. This report gives an overview of data contained within the Costs Book 2019/20. (All dates refer to financial years – for example, ‘2019/20 refers to the year beginning 1st April 2019 and ending 31st March 2020.) Many of the figures in this report have been rounded. Some figures for the current year may not be directly comparable to those for previous years. While every attempt is made to make comparisons of the data possible, changes in accounting methodology must be considered along with other factors such as organisational change or missing data. See Summary of Changes for important changes about the 2019/20 data.

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Context of the Report

The statistics presented for this period may be affected in part by the COVID-19 (Coronavirus) outbreak. In particular, on the 17 March, all NHS Boards in Scotland were placed in special measures and Boards were asked to suspend all non-urgent elective treatment, subsequently on the 23 March the nation entered a period of ‘lockdown’. These measures and the response to treat and care for those infected by the virus impacted on normal referral and treatment patterns in March and so this will have influenced the cost of services affected. Although this occurred very late in the financial year, and so impact may be minimal, this should be taken into consideration when interpreting the statistics released.

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Main Points

Some of the key findings for 2019/20 are: • £13.2 billion was spent on these health service operating costs. This represents a 6.6% (£811m) increase on the £12.4bn spent in 2018/19. Once adjusting for inflation (real terms), total operating costs, increased by 4.5% compared to 2018/19. The corresponding increase between 2017/18 and 2018/19 was 0.6%.

• The £811m increase in expenditure was not shared evenly across the different sectors. Of the total increase, £499m (62%) was spent on hospital services, £203m (25%) on community services and £99m (12%) on family health services.

• As part of the 3-year Agenda for Change (AfC) pay settlement; in 2019/20 staff costs increased as a consequence of a 3% pay increase for the majority of staff and compression of AfC pay bands, resulting in a larger jump between progression points. Agenda for Change is the national NHS pay system, with harmonised terms and conditions. In addition, there has been an increase in employer’s superannuation contributions for all staff in the NHS pension scheme. This impacted on the expenditure within the Hospital and Community Sectors, where there are high numbers of staff on AfC contracts. • Expenditure on hospital services was £7.3bn, a cash terms increase of 7.3% and a real terms increase of 5.3%, when compared to the previous year.

• Expenditure on community services was £2.6bn, a cash terms increase of 8.3% and a real terms increase of 6.3%, when compared to the previous year.

• Family health services expenditure, which includes the cost of running local GP practices in addition to the local pharmacy, dental and ophthalmic services, amounted to £2.8bn, which represented a cash terms increase of 3.7% and a real terms increase of 1.7% compared to the previous year. This smaller comparative increase in expenditure, was in part due to the sector having a higher number of contractors, with different remuneration arrangements to the AfC staff.

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Results and Commentary

1. Total Operating Costs

In the financial year 2019/20, £13.2bn, was spent on operating costs by the 14 territorial NHS Boards and the two special Boards, the State Hospital and the National Waiting Times Centre (Golden Jubilee). This represented an increase of 6.6% (£811m) on the previous year – in real terms, after adjusting for inflation, it reflects a 4.5% increase. Table 1 shows how this expenditure has increased over the last five years, in both cash terms and real terms. Real terms expenditure has increased by 8.2% from £12.2bn in 2015/16 to £13.2bn in 2019/20.

Table 1: Trends in operating costs, 2015/16 - 2019/20

Financial Year Cash Terms Change on Real Terms1 Change on Operating Costs Previous Year Operating Costs Previous Year (£000) (Cash Terms) (£000) (Real Terms) 2019/20 13,173,138 6.6% 13,173,138 4.5% 2018/19 12,362,480 2.8% 12,601,660 0.6% 2017/18 12,026,998 2.9% 12,521,210 1.2% 2016/17 11,687,450 4.1% 12,377,888 2.8% 2015/16 11,226,453 3.9% 12,171,180 3.1% 1. Note: To obtain ‘real-terms’ figures, the costs have been divided by an adjustment factor (GDP deflator) determined by HM Treasury. Real terms costs show approximately what the services provided in that year would have cost in 2019/20.

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1.1 NHS Costs by Sector

The £13.2bn Total Operating Costs are distributed between Hospital, Community and Family Health Services as well as Resource Transfer (an historic transfer of funding to Local Authorities for the provision of services, such a community care packages, which are a combination of services put together to meet a person's assessed needs as part of the care plan arising from an assessment). Figure 1 shows the operating costs for these services in both cash and real terms over the past ten years (2010/11 to 2019/20). Total Operating Costs, have increased by 15.0% in real terms over the 10-year period since 2010/11, a real terms increase of £1.7bn, from £11.5bn in 2010/11. In real terms the costs for Hospital Services have increased by 12.9%, from £6.5bn in 2010/11 to £7.3bn in 2019/20. Expenditure for Community Services increased by 46.6% from £1.8bn to £2.6bn. Family Health Services costs increased slightly by 0.5% to £2.8bn over the same time period.

Figure 1: Trends in real terms operating costs by sector, 2010/11 - 2019/20

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Table 2 shows expenditure distribution in monetary and percentage terms across the services over the last 5 financial years. In 2019/20 Total Operating Costs increased by 6.6% (£811m) in cash terms. This included a 7.3% (£499m) increase in Hospital Operating Costs, an 8.3% (£203m) increase in the cost of Community Services and 3.7% (£99M) increase for the Family Health Sector. Hospital Services remain the largest sector, with over half of Total Operating Costs, Community Services and Family Health Services spend 20.1% and 21.3%, respectively, with the remaining 3.2% for Resource Transfer. The proportion of spend on Hospital Services had been reducing, since 2015/16 but rose slightly in 2019/20 to 55.5%, although still remains below the 2015/16 share. Since 2015/16, proportionally Community Services has increased the most from 17.2% to 20.1%. However, the proportion of the overall spend for Family Health Services has reduced from 22.6% to 21.3%, since 2015/16.

Table 2: Trends in operating costs (£bn) by sector, 2015/16 - 2019/20

Financial Year Operating Costs (£bn) 2015/16 2016/17 2017/18 2018/19 2019/20 Cash Terms Total 11.23 11.69 12.03 12.36 13.17 Hospital 6.38 6.48 6.61 6.81 7.31 Community 1.93 2.23 2.39 2.44 2.64 Family Health 2.53 2.59 2.62 2.70 2.80 Resource Transfer 0.38 0.39 0.40 0.41 0.42 Real Terms Total 12.17 12.38 12.52 12.60 13.17 Hospital 6.92 6.86 6.89 6.94 7.31 Community 2.09 2.37 2.48 2.49 2.64 Family Health 2.75 2.74 2.73 2.75 2.80 Resource Transfer 0.42 0.41 0.42 0.42 0.42 Cash Terms (%) Total 100.0% 100.0% 100.0% 100.0% 100.0% Hospital 56.9% 55.4% 55.0% 55.1% 55.5% Community 17.2% 19.1% 19.8% 19.7% 20.1% Family Health 22.6% 22.1% 21.8% 21.9% 21.3% Resource Transfer 3.4% 3.3% 3.3% 3.3% 3.2%

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1.2 NHS Costs by Health Board

The distribution of expenditure across sectors can vary between territorial Health Boards. This can be driven by a number of factors, including differing demographic and health needs within the populations serviced as well as the requirement to deliver and adapt services to different geographical landscapes and areas of low or high population density. Figure 2 below, shows this variation in distribution of spend by sector, for each of the 14 territorial boards as well as Scotland. NHS Tayside, Greater Glasgow & Clyde, Lothian and Grampian, all have above national average (55.5%) proportions of spend on the Hospital Sector, as they provide specialist services on a regional basis, treating a larger number of patients from other Board areas. Shetland has the lowest proportion of spend on the Hospital Sector, 44.4%, but has a higher proportion of spend on Family Health Sector, 27.7%, compared to the national average of 21.3%. NHS Greater Glasgow & Clyde has the lowest proportion of spend on Community Sector at 19.3%, compared to a national share of 20.1%. NHS Shetland has the highest proportion of the territorial boards, with 27.7%. Highland’s proportion of Resource Transfer expenditure, 7.6% is more than double that of Scotland, 3.2% due to its unique lead agency arrangement for health and social care integration.

Figure 2: Health Board distribution of Total Operating Costs, 2019/20

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2 Hospital Sector Hospital Services deliver different types of patient care such as treatment for an inpatient or day case or through attendance at an outpatient or A&E department. Figure 3 compares the expenditure (in real terms) on some of the main types of care between 2015/16 and 2019/20. For completeness it includes an ‘other’ category reflecting costs that cannot be directly attributed to these types of care. This includes some hospital running and administration costs as well as costs for some other types of ambulatory care. In 2019/20 inpatient care accounted for half (£3.7bn) of the cost of hospital services whilst outpatient services accounted for a further 14.5% (£1.1bn), long stay inpatient care 9.8% (£718m), day case treatment 7.9% (£575m), A&E 3.4% (£251m) and day patient services 1.1% (£78m). ‘Other’ accounted for 13.0% (£951m) in 2019/20. Figure 3 shows the total expenditure in real terms by care type. Spend on the Hospital Sector increased by £387.5m between 2015/16 and 2019/20. An additional £201.6m (5.8%) was spent on inpatient services, £138m (15.0%) on outpatient services and £37m (17.3%) on A&E departments. Expenditure on long-stay inpatient care and services for day patients reduced by £14.4m (2%) and £35.5m (31.4%), respectively.

Figure 3: Hospital Service costs (real terms) by type of care, 2015/16 - 2019/20

Figure 4 and Figure 5, over, show the average cost per patient episode or case (and how this changed over the last five years in real terms).

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Figure 4: Hospital Services average cost per case (real terms) by type of care, 2015/16 - 2019/20

Measurement of average costs vary by care type, inpatient and day case are measured per episode, while day patients, outpatients and A&E are measured per attendance. Note that the length of an inpatient episode (how long the patient stays in hospital) can vary considerably as well as the complexity of the care and treatment provided during the episode. This means there is also greater variation in the costs of individual episodes or across average costs for different specialties. This variation should be borne in mind when considering the average costs presented here. Adjusting for inflation, average costs per case have increased across all care types, with the exception of day patients, since 2015/16. The average cost for long stay patients is the highest across all the care types at £3,683 per week an increase of 18.7% since 2015/16. The cost per case for inpatients increased by 11.0% over the 5 years to £3,314 in 2019/20. This may be in part due to a shift of less complex treatment away from Inpatient care to ambulatory care, such as day case or outpatient, resulting in the remaining activity to being more complex overall and so more expensive.

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Figure 5: Percentage change in real terms for average cost per case, 2015/16 – 2019/20

Figure 6, shows the distribution of hospital activity by patient type during 2019/20. Outpatients attendances accounted for almost 60% of all activity, with A&E attendances comprising 18%. Inpatient cases and long stay inpatient weeks’ account for 12% and 2%, respectively, of all activity.

Figure 6: Hospital Services activity by care type, 2019/20

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3 Community Sector The Community Sector covers services delivered outside hospitals within communities, such as mental health and learning disabilities, district nursing, health visiting, home dialysis. As with the Hospital and Family Health Sector costs, Community costs have risen, in real terms, year on year since over the past 5 years, from £2.1bn in 2015/16 to stand at £2.6bn in 2019/20. Adjusting for inflation this is an increase of £550m (26%) since 2015/16 and the Community Sector now accounts for 20.1% of Total Operating Costs (Table 2), as opposed to 17.2% in 2015/16. Figure 7 shows expenditure that can be attributed to particular types of community services and shows how the cost of these categories differs from 2015/16, after adjusting for inflation.

Figure 7: Community Services expenditure (real terms), 2015/16 and 2019/20, excluding other services.

The category shown, with the highest spend was ‘sub-contractors. This covers funding to the voluntary or private sectors and local authorities for the provision of community services, reflecting greater collaboration with these sectors around integrated health and social care services. Health visiting and specialist nursing services had the largest percentage growth in spend over the 5 years to 2019/20, 18.6% and 18.0%, respectively. Spend on mental health & learning disabilities grew from £268m in 2015/16 to £314m in 2019/20, an increase of 17.1%. Spend also increased, but at a slower rate, for allied health professionals, which includes

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chiropody, dietetics, occupational therapy, physiotherapy and speech therapy services, up 5.1% to £8.1m in 2019/20. Only dentistry, addiction services and home dialysis experienced a drop in costs of 13%, 9% and 7%, respectively. The reduction in addiction services spend, from 2015/16 to 2019/20 of £7.2m, in real terms, is a consequence of the alcohol and drug partnership spend, being re- classified as a health service purchased form sub-contractor as the related services purchased with this expenditure, are not provided by the NHS Boards. As such this is now included in the sub-contracting expenditure, detailed previously.

Within the Community Sector costs, there is some expenditure that cannot be attributed to a specific service, and this is grouped together as ‘other services’. This includes primary care funds, administration costs as well as other costs not attributed to any of the other accountable community services. Other services accounts for a third of the overall Community Sector spend. Between 2015/16 and 2019/20, ‘other services’ increased by 17.3% in real terms from £750m in 2015/16 to £880m in 2019/20.

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4 Family Health Sector The Family Health Sector had an expenditure of £2.8bn in 2019/20, which represented a year on year increase in real terms of 1.7%. This sector includes: • Pharmaceutical Services (community pharmacy, in hospital drug dispensing, the provision of medicines, dressings, instruments and sundries). • Primary Medical Services (PMS), covering GP services across Scotland, with the exception of Out of Hours GP services as these are provided by the NHS Boards and the expenditure is accounted for within the community services costs. • General Dental Services (GDS), covering the cost of subsidising dental care and treatment provided by dental practices, as well as paying for national programmes to improve dental hygiene, such as ‘Childsmile’. • General Ophthalmic Services (GOS), covering the costs of free eye tests, at high street opticians and optical vouchers which cover the cost of prescription glasses, for those eligible. Figure 8 shows the breakdown of expenditure for these categories in 2019/20. Pharmaceutical Services expenditure made up the largest proportion (47.2%) of Family Health Service expenditure. The PMS services share of the budget was one third. Together GDS and GOS accounted for almost 20% of the overall Sector expenditure with GDS accounting for 15.5% and GOS for 4.0% in 2019/20.

Figure 8: Family Health Service operating costs, 2019/20

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Figure 9: Family Health Service operating costs split by service, 2015/16 – 2019/20

Figure 9, shows the 5 year change in expenditure for the four types of service. PMS has, in real terms, seen an increase of £83.5m (9.8%) since 2015/16 and a £40.8m (4.6%) increase since 2018/19, with £934m being spent in 2019/20. Across the same period the number of GP Practices in Scotland has decreased from 981 in 2015/16 to 925 in 2019/20, but with an increased patient list size of 5,758,276 people, which is 130,809 (2.3%) more than the number of people in 2015/16.

The cost of providing GDS was £435m in 2019/20, a real terms increase of £2.8m (0.7%) since 2018/19 and a reduction of £2.5m (0.6%) since 2015/16. Over the past 5 years there has been an additional 390k registrations in dental patients. In 2019/20, GOS cost £111m, in real terms a reduction of £0.5m compared with 2015/16 and £0.4m from 2018/19. There were 2.2m sight tests performed in 2019/20, an increase of 4.6% on 2015/16 but a 6.1% drop on the number of sight tests carried out in 2018/19. In 2019/20, Pharmaceutical Services cost £1.32bn, a real terms decrease of £24.1m (1.8%), from the 2015/16 costs. To place this in context, these costs accounted for 11% of Total Operating Costs in 2015/16, but by 2019/20 this had dropped to 10%. Within this, drug expenditure accounted for the vast majority of the costs, 80.5% in 2019/20 compared with 83.1% in 2015/16. Figure 10 shows the trend in drugs expenditure from 2015/16 to 2019/20 in real terms. Spend on drugs was £1.1bn in 2019/20, a reduction of £13m (1.2%) in real terms on the previous year and £53m (4.8%) on 2015/16. In cash terms there was a year on year increase of £7m (0.7%) and a five-year increase of £33m (3.2%).

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Figure 10: Community drugs expenditure (real terms), 2015/16 - 2019/20

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5 Staff Costs

In 2019/20, almost half (49%) of the total operating expenditure (£6.4bn) related to the cost of the workforce employed to deliver the services largely within the Hospital and Community Sectors. This workforce is diverse, comprising a number of staff groups including clinical staff, such as doctors, dentists, nurses, midwives and allied health professions, as well as managers, health scientists, administrative and clerical staff and other support staff. This includes staff who are directly and permanently employed as well as bank and agency staff. It excludes the cost of independent contractors, such as General Medical Practitioners (GPs) and General Dental Practitioners, and the staff they employ. It also excludes the cost of laboratory staffing who support both Hospital or Community sectors. The cost of laboratory staff is available via the R700 and R740 reports, which detail laboratory spending. In 2019/20 this was £212.6m, a small real terms increase of £3.1m from the £209.5m in 2015/16. Figure 11 shows how these staffing costs have changed in recent years. Compared to 2018/19 Hospital and Community staff costs have increased by £420m in real terms (7.0%). This increase was considerably more than in previous years where growth over the previous 4 years was around one or two percent per annum (adjusting for inflation). This increase was in a large part due to the 3 year pay settlement for staff on Agenda for Change pay and conditions (this was originally introduced in 2006, bringing in new pay bands and harmonised terms and conditions across the NHS workforce). This meant that in 2019/20 there was a 3% pay increment, additional pension contributions, compression to grades and pay progression points, resulting in increased staff costs. Over the previous five years, 2015/16 to 2019/20, the corresponding real terms increase in Hospital and Community staff costs was 10.7% (£622m).

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Figure 11: Trends in staff costs, 2015/16 - 2019/20

In 2019/20, 77.6% of staff expenditure went on Hospital Staff and the remaining 22.4% on Community Staff. This split has remained constant over the past 5 years. In real terms, spend on staff has increased by £387m (8.4%) to £5.0bn in Hospital services and by £234m (19.4%) to £1.4bn in Community services since 2015/16. As noted in the 2019/20 Costs Book, the number of WTE’s in Hospital services has increased by 2.1% to 100k and the number employed in Community services has increased by 11.2% to 30k.

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Glossary GPD Deflator A measure of price inflation or deflation with respect to a specific base year. The GDP deflator of the base year is equal to 100. Board Operating The annual costs incurred by a Board in running its business of Costs healthcare. Cash Terms A measure of the value of money without adjusting for the effect of inflation. Financial Year Period of time beginning in April and ending in March (e.g. Financial Year 2018/2019 begins on 1st April 2018 and ends 31st March 2019). Hospital Running The total revenue expenditure (pay, supplies and services) for a Costs hospital, incurred in providing a service to patients. NHSScotland National Health Service Scotland. Real Terms A measure of the value of money that removes the effect of inflation. Resource Transfer Transfer of monies from NHS to fund health care provided by local authorities, such as community-based care packages and the support infrastructure for patients discharged from long stay hospitals. Scottish Financial A series of templates used for standardising the return of the Returns (SFRs) Costs Book data from Boards.

Additional costing information and guidance can be found within the Reference and Financial Definitions sections of the PHS website.

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Contact Edmund Anderson Principal Information Analyst 0141 282 2182 [email protected]

Further Information Further information and data for this publication are available from the publication page on our website. The next release of this publication will be 16 November 2021.

Open data Data from this publication is available to download from the Scottish Health and Social Care Open Data Portal.

Rate this publication Let us know what you think about this publication via. the link at the bottom of this publication page on the PHS website.

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Appendices Appendix 1 – Background information Appendices

A1 – Background Information

Costs Book Data Collection System

Additional information on Data Quality Assurance can be found within the Summary Guidance document.

Reference Information The collection of costs data is supported by a number of guidance manuals, reference files and systems logic to ensure consistency and quality of the Costs Book. These include: Annual accounts manual Costing Guidance manual Costs Book Reconciliation to Annual Accounts Scottish Financial Returns Additional costing information and guidance can be found within the Summary Guidance and Costs Book Reference section of the PHS website.

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Appendix 2 – Publication Metadata

Metadata Indicator Description Publication title Scottish Health Service Costs, year ended 31 March 2019 Description Scottish Health Service Costs (known as the ‘Costs Book’) provides a detailed analysis of how Board operating costs, reported in Board annual accounts, have been spent on patient care within NHS Scotland. Theme Health and Social Care Topic Hospitals and Health Care Format Web pages, Excel and PDF files Data source(s) Information contained in the Costs Book is primarily derived from Scottish Financial Returns (SFRs) which are compiled by NHS Boards, and completed as part of their annual accounts cycle. The Costs Book Data Collection System (CBDCS) is a web-based data collection system issued to NHS Boards to assist them in compiling and submitting the SFRs to PHS on an annual basis. A central version of CBDCS is held at PHS which holds data returns from NHS Boards. To support data collection and submission, PHS provides NHS Boards with a comprehensive Costs Guidance Manual. To ensure consistency across all NHS Boards, this manual is updated on a regular basis with input from NHS Boards, the Scottish Government and PHS. In addition, a supplement to the Costing Guidance manual with information specific to the coming year’s collection is provided to NHS Board staff. The collection of costs data is supported by a number of guidance manuals, reference files and systems logic to ensure consistency and quality of the Costs Book. Additional costing information and guidance can be found within the Summary Guidance document and the Costs Book Reference section of the PHS website. Date that data was acquired October 2020 to January 2021

Release date 23 February 2021 Frequency Annual Timeframe of data and April 2018 to March 2019 timeliness

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Continuity of data Some figures for the current year are not directly comparable to those for previous years. While every attempt is made to make comparisons of the data possible, changes in accounting methodology must be considered along with other factors such as organisational change or missing data. See Summary of Changes for important changes about the 2018/19 data. When making comparisons across Scotland, or interpreting the Costs Book data, it should be noted that individual NHS Boards/hospitals (e.g. island Boards) can face low volume of patients, fixed costs, economies of scale and rural settings which can result in substantial fluctuations in unit costs and case figures for some hospitals. To aid user interpretation, footnotes are included at the bottom of tables where possible. More information on Continuity of Data can be found within the Summary Guidance document, Summary of Changes document and Costs Archive webpage. Revisions statement Figures contained within the R100 and R100T reports may be subject to change in future publications. On a yearly basis, there can be numerous changes to the Costs Book data templates and to the accounting guidance. Every attempt is made to make year-on-year comparisons of the data possible. Revisions relevant to this Any revisions relevant to this publication will be contained publication within the R100 and R100T reports. Concepts and definitions The collection of costs data is supported by a number of guidance manuals and reference files. These include: Annual Accounts manual Costing Guidance manual Costs Book Reconciliation to Annual Accounts Scottish Financial Returns Data included in each report and how the figures are calculated can be found within the Report Logic. Additional costing information and guidance can be found within the Reference and Financial Definitions section of the PHS website.

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Relevance and key uses of Scottish Health Service Costs (often referred to as the the statistics ‘Costs Book’) is published annually by PHS, with the support of the Scottish Government Health Department (SGHD). The Costs Book is the only source of published costs information for NHSScotland, and provides a detailed analysis of where resources are spent in NHSScotland. The Costs Book publication ensures that comparative information on health service costs is publicly available. The information is used in many applications: for example, to ensure greater efficiency by allowing benchmarking comparisons to be made between healthcare providers; and to predict future healthcare resource need in the context of resource allocation. Other uses of the data include supporting NHS Boards, public health researchers and pharmaceutical organisations, and fulfilling Freedom of Information Requests and Parliamentary Questions. Accuracy The quality of these statistics is such that they are considered fit for publication. Robust quality assurance is carried out between PHS and NHS Boards to ensure accuracy and completeness. More information on Data Quality Assurance can be found within the Summary Guidance document. Despite the efforts of the PHS Data Management team, there can be some data quality factors that are out with their control. For example, unavailability of some statistics such as theatre hours – in this case, NHS Boards are instructed to use estimates. When making comparisons across Scotland, or interpreting the Costs Book data, it should be noted that individual NHS Boards/hospitals (e.g. island Boards) can face low volume of patients, fixed costs, economies of scale and rural settings which can result in substantial fluctuations in unit costs and case figures for some hospitals. To aid user interpretation, any data quality issues or factors are footnoted at the bottom of tables where possible. Information contained in Costs Book is primarily derived from Scottish Financial Returns (SFRs) which are compiled by NHS Boards, and completed as part of their annual accounts cycle. NHS Board annual accounts are audited by an independent body before being agreed by the Scottish Government. While there is no audit of the Costs Book, Boards are required to show how the costs included in the

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Costs Book reconcile to expenditure and income reported in the Statement of Comprehensive Net Expenditure (SOCNE) from the annual accounts. To support this process, the SG is responsible for providing NHS Boards with an Annual Accounts manual. PHS also issue data templates (SFR 29.0) to record this reconciliation. NHS Boards are also provided with comprehensive guidance on standard principles and recommended practices to be applied in the production of their cost information. One of the key principles is that the costing process should be transparent with a clear audit trail. Completeness A complete financial analysis is included for all relevant NHS Boards. Comparability Hospital bed information, hospital patient activity and staffing information are broadly comparable with other PHS publications. See Costs, Workforce and Hospital Care for more information. There is not a similar publication to the Costs Book for the NHS in other parts of the country. Therefore, these figures may not be comparable with other regions of the UK. For costs information for the NHS in England please see NHS Reference Costs. Changes in accounting methodology and other factors mean that some figures for the current year are not comparable to previous years. Please see the relevant Summary of Changes document and the relevant notes pages for further information. To make year on year figures as comparable as possible the costs for years prior to 2019/20 have been adjusted for inflation (fixed terms costs). This has been done by using HM Treasury’s GDP deflator. More information on this can be found by browsing the relevant pages on the Treasury website. For important information about the 2019/20 data see Summary of Changes. File listings for previous years are also available from the Costs Archive. Accessibility It is the policy of PHS Scotland to make its web sites and products accessible according to published guidelines. Coherence and clarity Scottish Health Service Costs reports on how £13.2billion of operating costs were spent in 2019/20 in providing hospital and primary care to patients, through geographical NHS Boards, the State Hospital and the Golden Jubilee

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National Hospital. Information on expenditure in the Scottish Ambulance Service and in National Services Scotland (including the Scottish Breast Screening Programme) is also provided. Statistics are presented within Excel spreadsheets and PDF documents. The following links provide short cuts to the 2019/20 data files for technical users: Reports – Excel files designed for viewing (note: some files include macros) Downloads – Excel files designed for further data analysis SFRs – Excel files giving access to the source data For important information about the changes to the 2019/20 data, and also historical changes, see Summary of Changes. File listings for previous years are also available from the Costs Archive. Value type and unit of Data included in each report and how the figures are measurement calculated can be found within the Report Logic. Disclosure The PHS protocol on Statistical Disclosure Protocol is followed. Official Statistics designation National Statistics UK Statistics Authority National Statistics Assessment Last published 19 November 2019 Next published November 2021 Date of first publication 1960s, but in its current format/content since 2000 Help email [email protected] Date form completed 23 February2021

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Appendix 3 – Early access details

Pre-Release Access Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", PHS is obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre- Release Access.

Standard Pre-Release Access: Scottish Government Health Department NHS Board Chief Executives NHS Board Communication leads

Early Access for Management Information These statistics will also have been made available to those who needed access to ‘management information’, ie as part of the delivery of health and care:

Early Access for Quality Assurance These statistics will also have been made available to those who needed access to help quality assure the publication:

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Appendix 4 – PHS and Official Statistics

About Public Health Scotland (PHS) PHS is a knowledge-based and intelligence driven organization with a critical reliance on data and information to enable it to be an independent voice for the public’s health, leading collaboratively and effectively across the Scottish public health system, accountable at local and national levels, and providing leadership and focus for achieving better health and wellbeing outcomes for the population. Our statistics comply with the Code of Practice for Statistics in terms of trustworthiness, high quality and public value. This also means that we keep data secure at all stages, through collection, processing, analysis and output production, and adhere to the ‘five safes’.

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