Audit Scotland logo

Forward work consultation

Proposed programme of performance audits 2012/13

Priorities for publication 2012/13 (in proposed order of publication)

  1. Learning the lessons of public body mergers
  2. Tackling health inequalities in Scotland
  3. Developing a skilled workforce – National Training Programme
  4. Major projects – managing capital investment in local government
  5. GP prescribing
  6. Consumer services in local government
  7. Justice (topic to be identified following completion of the justice overview)
  8. Scotland's Public Finances 3: Workforce planning in times of reducing budgets
  9. Efficiency of clinical services
  10. Renewable energy

Proposed performance audits to be kept under review in rolling forward programme (in alphabetical order)

  1. Charging for services in local government
  2. Climate change duties
  3. Commonwealth Games – 3rd position statement covering legacy issues
  4. Crime prevention/ community safety
  5. Drug and alcohol services in Scotland follow-up
  6. E-health
  7. Early intervention in improving health
  8. Housing overview / affordable housing
  9. Intervention in early years
  10. Major transport infrastructure projects – watching brief
  11. Mental health follow-up – dementia services
  12. Outsourced contracts
  13. The Scotland rural development programme
  14. Support to small and medium enterprises
  15. Sustainability of higher and further education
  16. Telecare: equipment and services to help people remain in their own home
  17. Young people leaving care

Back to top

Summary of proposed performance audits 2012/13

1. Learning the lessons of public body mergers

The Scottish Government has sought to increase public sector efficiency and the delivery of better outcomes through its Simplification Programme launched in 2008. Through a mix of transfers, dissolution and merger, new public bodies now (or soon to be) established include Skills Development Scotland (2008), Creative Scotland and National Records of Scotland (2010), Social Care and Social Work Improvement Scotland (2011) and Scottish Education Quality And Improvement Agency (2011).

Mergers are also taking place in higher and further education, whilst wider organisational change is a potential outcome from the Christie Commission, due to report in June 2011. Structural reform of policing and fire and rescue services in Scotland is also under active consideration.

The merger of public bodies creates the potential for financial savings but mergers must be well planned and managed, and the new bodies must be able to demonstrate performance that is at least on a level with their predecessor bodies. Key audit questions could include:

  • How well have public body mergers been planned and managed?
  • What financial savings have resulted from mergers compared to plans?
  • What has been the performance of public bodies created from mergers?
  • What are the lessons for future mergers and organisational improvements in the public sector?

Back to top

2. Tackling health inequalities in Scotland

Scotland has poorer health and lower life expectancy compared to the rest of the UK and other Western European countries. Life expectancy has improved in Scotland over recent years but healthy life expectancy is lagging behind. There are significant health inequalities between the least deprived and most deprived areas of Scotland. There are considerable costs associated with poor health and inequalities.

The Scottish Government estimates there was around £607.3 million of specific funding for health inequalities in 2010/11.  In addition to this, a significant amount of NHS and council spend will be used to tackle health inequalities.  In June 2008, the Scottish Government published the Equally Well strategy, followed by an action plan in December 2008. Key audit questions could include:

  • How well has the Scottish Government implemented Equally Well and how is it monitoring progress?
  • How much is spent on tackling health inequalities, how does this vary across the country and where has the spend been targeted?
  • Does this represent value for money?
  • Are there successful approaches and good practice in tackling health inequalities that can be applied in Scotland?

Back to top

3. Developing a skilled workforce – National Training Programme

Developing a highly skilled workforce that matches the needs of businesses is a priority for the Scottish Government. Despite Scotland's skills base improving considerably in the last 10 years, this has not translated into higher productivity and economic growth.

The Scottish Government has emphasised the importance of National Training Programmes (NTPs) in helping to develop an appropriately skilled workforce to support economic recovery. There are four NTPs: Modern Apprenticeships; Get ready for work; Training for work; and Skillseekers.

In 2009/10 over £109 million was spent on the four NTPs and the Scottish Government has pledged additional funding to increase the number of training places available. Skills Development Scotland (SDS) oversees the delivery of the four NTPs. The Scottish Government has set a target of 46,500 fully funded training opportunities, including 25,000 Modern Apprenticeships, to be offered in 2011/12. Key audit questions could include:

  • What are the aims of the National Training Programmes?
  • How well are programmes aligned to current and projected growth sectors?
  • How accessible are the programmes to those with skills needs?
  • How have National Training Programmes contributed to the national performance framework targets?
  • How effective have the National Training Programmes been in securing sustained employment outcomes?

Back to top

4. Major projects – managing capital investment in local government

Local government capital spending in 2009/10 was around £3.3 billion, including £1.3 billion spent on education services, £500 million on housing revenue account and £470 million on roads and transport. The investment was mainly financed by borrowing (£1.9 billion, including £824 million finance leases and PFI/PPP) and £890 million Scottish Government direct grant. Around another £3.5 billion further investment is expected in new schools and waste facilities, with a significant part to be financed through Non-Profit Distributing and similar projects.

This would be the first across-the-board audit of major project investment in local government in Scotland. It would build on previous Audit Scotland reports on major investment. Key audit questions could include:

  • How well have councils managed recent major investment projects and their delivery to cost, time and quality?
  • Are councils managing projects currently in progress and the investment programme as a whole in line with good practice?
  • What level of finance is available to meet investment needs and what are the financial implications of greater use of private finance for schools and waste projects?
  • What are councils doing to co-ordinate major investment and share skills and experience to promote effective spending and continuous improvement?

Back to top

5. GP prescribing

Primary care prescribing cost the NHS £946 million in 2009/10 and is one of the most significant cost pressures facing the NHS. The Scottish Government identified reducing costs and improving quality in primary care prescribing as a workstream in the NHSScotland Efficiency and Productivity Framework, published in February 2011. Audit Scotland has looked at this previously in 1999 and 2003. The 2003 report identified scope for the NHS to make further efficiency savings of around £14 million through improved prescribing and medicines management.

Prescription charges have reduced in Scotland in recent years, and were abolished in April 2011. Charges have also been abolished in Wales but they have increased in England, rising to £7.40 on 1 April 2011. Key audit questions could include:

  • How are NHS boards performing against a range of quality and efficiency indicators?
  • What is the scope for further efficiency savings?
  • How does performance against the quality and efficiency indicators compare across the UK?
  • What impact has the abolition of prescription charges in Scotland had on prescribing rates and costs? How does the trend compare with other areas of the UK with different charging policies?

Back to top

6. Consumer services in local government

Trading standards and environmental health services in local authorities exist to protect consumers. Last year, Consumer Focus Scotland published a report which suggested that there is limited understanding of consumers’ experiences of dealing with trading standards services; no effective system to measure the performance of trading standards services; and wide variation in the resources available to trading standards services. Key audit questions could include:

  • How do local authorities assess consumers’ views of their consumer protection services?
  • What performance information do local authorities have about their consumer protection services and how is performance benchmarked?
  • Do consumer protection services have the capacity to deliver an effective service?
  • How much do local authorities spend on consumer protection services?

Back to top

7. Justice - topic to be identified following completion of the justice overview (2011 programme)

Audit Scotland is currently undertaking a high-level review of Scotland’s justice system. This overview will identify how much public money is spent on delivering the justice system in Scotland, what this money delivers and where the main challenges are within the system. The report is due to be published in September 2011.

One of the aims of the overview is to use the findings to identify specific areas or services where more detailed performance audit work might be of benefit. Following publication, we will bring forward proposals for further performance audit work in the justice sector for consideration by the Accounts Commission and the Auditor General.

Back to top

8. Scotland's Public Finances 3: Workforce planning in times of reducing budgets

The Scottish Government’s DEL budget will reduce in real terms by 11 per cent in the period to 2014/15, which may result in up to 30,000 public sector jobs being lost. While workforce reductions will help reduce costs, there are risks around the potential loss of key skills and corporate knowledge because of staff leaving; the staff who remain may lack the training and skills to undertake the work of former staff; and morale among remaining staff could be affected by fears of further job losses.

This audit would build on Scotland’s Public Finances: Addressing the challenges, which will be published in August 2011, to look in more detail at how public bodies are planning for workforce reductions and for managing with fewer staff. Key audit questions could include:

  • How many jobs have been lost in the public sector since 2010/11 and how many further job losses are planned?
  • What are the costs and the expected net savings arising from workforce reductions?
  • To what extent is the reduction in staff numbers driven by longer-term analysis of workforce capabilities and requirements?
  • To what extent have local authorities used the move to single status to review terms and conditions of employment?
  • What are public bodies doing to ensure that there is a match between the actual skills and experiences of the remaining workforce and what skills and experiences are required?

Back to top

9. Efficiency of clinical services

Audit Scotland published a report on the efficiency of Orthopaedics services in March 2010. This identified significant variation across Scotland and scope to use resources more efficiently and improve how services are managed. We are using a similar methodology for our current audit of Cardiology services and propose to look at another clinical area during 2012/13 – either Maternity services or Stroke services. Both are areas of high activity and spend, and both involve care being provided in both hospital and community settings.

In 2009/10, £277 million was spent on hospital maternity services and £40.5 million was spent on community midwifery. There were 110,700 inpatients, 24,000 day cases and 87,200 new outpatient attendances for maternity care.

Stroke is a national clinical priority for the NHS in Scotland and around 3,000 people die from a stroke every year. In 2010/11, there were 10,322 patients admitted to hospital with a stroke and around three per cent of men and two per cent of women in Scotland are living with stroke. It has been estimated that the cost of acute medical services for stroke patients in Scotland is at least £100 million a year. This excludes the costs of ongoing care in the community.

Key audit questions for a performance audit of either Maternity services or Stroke services could include:

  • What are the objectives for the service and how much is spent on it?
  • How do strategic plans for the service match projected changes in the population, including the availability of people of working age?
  • What scope is there to improve efficiency?
  • Does the service meet the needs of patients?

Back to top

10. Renewable energy

Scotland has achieved significant progress in increasing its renewable energy capacity and has significantly more ambitious targets than for the rest of UK. Scotland has a different incentive system for energy producers (the Renewables (Scotland) Obligation) to the rest of the UK. The scope of an audit could build on existing work by the National Audit Office and potentially cover the Scottish Government, Scottish Enterprise, Scottish Development International, Highlands and Islands Enterprise, Marine Scotland, the Scottish Funding Council and Skills Development Scotland. Key audit questions could include:

  • How much has been spent by the Scottish Government and the public sector on renewable energy?
  • What progress has been made against the Scottish Government’s renewables action plan?
  • What has been the effect of the Renewables (Scotland) Obligation?
  • What are the key challenges in meeting future targets?

Back to top

Summary of proposed performance audits to be kept under review in rolling forward programme

11. Charging for services in local government

In 2009/10, councils in Scotland received an estimated £1.1 billion of income from sales, fees and charges. Councils charge for many different services across all their areas of operation. Charges for social work services, such as adult and community care services, generated the largest amount of income in 2009/10 (£246 million).

Councils also receive income from most other services including environmental services such as licensing and cemeteries, from users of leisure and cultural facilities and for some education services such as adult and community learning and school meals. Charging has assumed greater importance as councils plan for significant reductions in their other income, such as grant funding from the Scottish Government and council tax revenues. The key audit questions could include:

  • How are charges for services set and to what extent are they based on the unit cost of delivering the service?
  • How accurate are councils’ forecasts of income from charging?
  • To what extent are councils relying on income from charges to bridge any funding gaps?
  • To what extent are users’ views taken into account when setting charges?

Back to top

12. Climate change duties

All Scottish public bodies became subject to climate change duties from 1 January 2011. All public bodies must contribute to reducing emissions of greenhouse gases and to adapting to climate change. The Scottish Government has provided guidance to public bodies on how to implement the duties but has not specified how public bodies should report their performance, nor set targets for public bodies.

This audit would complement the current performance audit on reducing emissions of greenhouse gases but should not begin until 2013 at the earliest. Key audit questions could include:

  • To what extent are public bodies demonstrating leadership in reducing emissions and adapting to climate change?
  • What is the performance of public bodies in reducing emissions and what has been the cost of making reductions?
  • What progress have public bodies made in making plans to adapt to climate change and how they costed these plans?
  • How effectively have public bodies reported their performance the duties?

Back to top

13. Commonwealth Games – 3rd position statement covering legacy issues

The 2014 Commonwealth Games is a major event for Scotland, involving significant amounts of public money and affecting the country’s international profile and reputation. Audit Scotland published its first report on planning for the delivery of the 2014 Commonwealth Games in November 2009.

This was the first in a planned series of performance audits, monitoring and reporting on progress. We will carry out a further review of progress in 2011 and, following publication, we will bring forward proposals for further performance audit work on the Commonwealth Games for consideration by the Accounts Commission and the Auditor General.

Back to top

14. Crime prevention/ community safety

Police forces, fire and rescue services and community safety partnerships are involved in a wide range of different initiatives to reduce crime, including early intervention individuals who are at risk of committing crime. Previous audit work has demonstrated that there is little systematic evaluation of these initiatives in relation to their comparative cost-effectiveness or the long-term financial and social benefits which could be achieved. Key audit questions could include:

  • How much is spent on crime prevention activities generally and early intervention in particular?
  • How much is known about the effectiveness of this spend, in both the short and longer term?
  • What are the most cost-effective approaches?

Back to top

15. Drug and alcohol services in Scotland follow-up

The impact of drug and alcohol misuse in Scotland is widespread with Scotland having high levels of drug and alcohol misuse compared to the rest of the UK. In March 2009, Audit Scotland published a report on Drug and alcohol services in Scotland. We estimated that in 2007/08, the public sector spent £173 million on drug and alcohol services in Scotland. Our report concluded that spending decisions were not away based on evidence of what is needed or what works. We also highlighted the need for the Scottish Government to set out the direction, roles and responsibilities of partner agencies and how performance will be assessed.

In May 2008 the Scottish Government published The Road to Recovery: A new approach for tackling Scotland’s drug problem and in March 2009, Changing Scotland’s relationship with Alcohol: A framework for action. In the last two years, the Scottish Government has also reshaped local partnership arrangements for drugs and alcohol and launched a delivery framework for local partnerships. The Scottish Government has also introduced a new target for access to drug services. A follow-up audit could focus on the recommendations from our 2009 report and at a national level, rather than collecting information from local agencies. Key audit questions could include:

  • Are clear national standards and performance monitoring arrangements in place?
  • Are governance and funding arrangements clear?
  • Have the new national arrangements been adopted in all local areas and are plans in place to improve services and demonstrate value for money?

Back to top

16. E-health

E-health is the use of information, computers and telecommunications in support of meeting the needs of service users. An estimated £225 million was spent on IM&T in the health service in 2004/05. The strategic spending review noted that the e-health budget would increase from £40 million in 2004/05 to £140 million in 2010/11.

The e-health programme, led by the Scottish Government, aims to change the way that information and related technology are used to meet patient needs. Following consultation, the Scottish Government is in the process of finalising an e-health strategy. Given the scale of investment and the continuing focus on improving technology in the health service a review of these schemes may be timely. Key audit questions could include:

  • How much is spent on e-health, including the national programme?
  • Are plans in place to improve e-health in Scotland and is there evidence of value for money from these schemes?
  • Are there appropriate structures and systems in place to deliver improvements in e-health?

Back to top

17. Early intervention in improving health

Scotland faces a number of complex public health challenges which affect not only the health of the population but also add to pressure on resources. Evidence shows that early intervention can have a positive impact on improving public health. An audit in this area could usefully focus on obesity which has a significant health and financial cost.

The rising prevalence of obesity in Scotland is a serious public health concern and prevalence levels in Scotland are considerably higher than in other European countries. Figures from the Scottish Health Survey show that in 2009 over 26 per cent of men and women were classed as obese. Childhood obesity is also a significant problem. Preventing and managing obesity involves interventions by the Scottish Government, NHS boards, councils and others. Key audit questions could include:

  • What are the trends in rates of obesity and related health problems?
  • How much is spent on obesity related health problems and on early intervention and how effective is this spend?
  • Is early intervention spend and activity effectively targeted at reducing health inequalities?
  • How effective are local and national planning, delivery and performance management arrangements for early intervention to tackle obesity and address obesity-related health inequalities?

Back to top

18. Housing overview / affordable housing

The budget for housing and regeneration is £393.8 million in 20011/12 – a real terms reduction of 20.5 per cent from 2010/11. Key groups, including representatives from the third sector, have expressed concern about the vulnerability of the housing sector at a time when demand for social housing is set to increase.

The housing sector faces significant challenges, including the need to deliver more affordable housing and addressing homelessness. We propose a review of housing in Scotland which may focus on a particular aspect such as affordable housing or may be a more general overview of the sector. Key audit questions could include:

  • How much is being spent and what services are provided by the public sector?
  • Is there clear leadership and planning at a national and local level?
  • How is the sector performing and how is it quality assured?
  • Are local demands for housing services assessed and are needs being met?

Back to top

19. Intervention in early years

There is a growing body of evidence that investing in services for children in the very earliest stages of life can deliver considerable savings to the public purse by preventing negative social outcomes in later life. The cost to the UK economy of continuing to address current levels of social problems is estimated at almost £4 trillion over a 20-year period. This includes addressing problems such as crime, mental ill health, family breakdown, drug abuse and obesity.

Significant reductions in public sector budgets coupled with projected increases in demand are likely to make it difficult for public sector bodies to fund extra investment in early years – ultimately leading to further increases in demand over the longer-term. An audit of intervention in early years could map out current spending and what it achieves, and make recommendations about where further savings could be made. Key audit questions could include:

  • How much is spent on early years services (for pre-birth to 3years old)? By which bodies?
  • How well have public bodies assessed the evidence base for investing in specific interventions?
  • How well have public bodies worked together to shift investment from care to prevention and what are their plans for future investment?
  • What savings could be achieved by increasing investment in early years and over what time period?

Back to top

20. Major transport infrastructure projects – watching brief

The Scottish Government’s capital DEL budget is expected to reduce by 36 per cent in real terms from £3.3 billion in 2010/11 to £2.1 billion to 2014/15, at a time when several major transport infrastructure projects such as the Edinburgh trams project, the Aberdeen Western Peripheral Route, the Borders Railway and the Forth Replacement Crossing are still ongoing.

Although we do not intend to undertake a review of the progress on major transport infrastructure projects at this stage, we will maintain a watching brief on these projects so that we are able to respond quickly to issues of public concern should they arise. Key audit questions for each major transport report could include:

  • What progress has been made to date against plans and what is the latest delivery date?
  • What costs have been incurred to date against budget and what is the latest forecast outturn?
  • How well are progress and costs being managed so that time and budget overruns are minimised?
  • How robust are project governance arrangements?

Back to top

21. Mental health follow-up – dementia services

Expenditure on mental health services amounts to approximately ten per cent of the overall health budget and around three per cent of all public spend. In 2004/05, the total cost was estimated at £1,059 million (NHS costs of £966 million and council costs of £93 million). Audit Scotland published an Overview of mental health services in May 2009. There is the potential to add value by developing our previous work in this area by focusing on a specific group of service users.

Dementia affects a significant number of people in Scotland and in 2010 there were around 71,000 people in Scotland living with dementia. The number of people with dementia is increasing, because the population is getting older; the number of people with dementia is set to double within the next 25 years. In June 2010, the Scottish Government published a Dementia Strategy and a range of actions are under way to help to improve dementia services in Scotland. Key audit questions could include:

  • How much do services cost and how well targeted are resources?
  • To what extent are services accessible to patients?
  • How do service providers ensure a comprehensive range of services?
  • How efficiently are services provided?

Back to top

22. Outsourced contracts

A range of public bodies rely on back-office functions that have been transferred to outside service providers through large scale outsourcing contracts. These contracts provide day-today support services in information technology and “business transformation” services, all with the objective of maintaining and increasing efficiency and productivity. The contracts may last for many years and involve expenditure of tens of £millions with major providers such as Serco, Fujitsu and BT.

An audit could assess the public sector’s performance in managing these complex contracts effectively. Key audit questions could include:

  • What are the costs of outsourced contracts across the Scottish public sector and what are the main benefits expected?
  • How well are public bodies managing their outsourced service contracts against good practice?
  • Are the contracts delivering the expected benefits within time and cost targets and what is their contribution to efficiency?
  • What is the effectiveness of the Scottish Government in supporting public bodies to improve contract management?

Back to top

23. The Scotland rural development programme

The Scotland Rural Development Programme (SRDP) is funded by the European Union and by the Scottish Government and represents a total investment of £1.5 billion between 2007-12. In contrast to previous rural development programmes, it aimed to promote economic and social goals in rural Scotland as well as improving the environment through a variety different funding schemes. The European Commission required a detailed mid-term review of the SRDP in 2010 which concluded that the programme had made significant progress. Key audit questions could include:

  • How strong are the programme’s governance arrangements?
  • What has been the demand for funding for the various elements of the SRDP?
  • What was the cost of administering the SRDP?
  • How has the effectiveness of the SRDP been evaluated?

Back to top

24. Support to small and medium enterprises

Business Gateway is intended to help new start and existing businesses to grow and prosper through a combination of online support, local workshops, training, impartial advice and specialist advisory services. Responsibility for providing Business Gateway services transferred from Scottish Enterprise and Highlands and Islands Enterprise to local authorities in 2009. Contracts for the provision of Business Gateway services are expected to be re-awarded in 2012. A review of Business Gateway services could look at performance and the quality of service provided following the transfer of responsibility to local authorities. Key audit questions could include:

  • What are the costs of providing Business Gateway services?
  • How efficiently are Business Gateway services provided?
  • What do users think of the quality of services provided under Business Gateway?
  • What is the impact of spend on Business Gateway services?

Back to top

25. Sustainability of higher and further education

The further education (FE) and higher education (HE) sector in Scotland plays a vital role in supporting economic growth and improving education and financial outcomes for individuals. In 2008/09, Scotland’s 43 colleges and 20 universities received a total of £3.4 billion, providing just over 600,000 student places. Scottish Government funding to the Scottish Funding Council, which distributes monies to colleges and universities, has reduced by 13.7 per cent from £1,786 million in 2009/10 to £1,541 million in 2011/12.

The Scottish Government proposes to provide additional income to universities from 2012/13 through increases in the tuition fees it pays to universities on behalf of Scottish students, and increases in the amount and scope of fees charged to other student groups. An audit could examine the current financial health of further and higher education, or focus on one sector alone, and consider action being taken to address future financial challenges at both the national and individual institution levels. Key audit questions could include:

  • How well is the sector performing against key financial indicators?
  • What are the risks to the financial sustainability of the sector over the longer term?
  • How well are individual institutions managing risks to ensure their future sustainability?

Back to top

26. Telecare: equipment and services to help people remain in their own home

Advances in modern technology are having an impact on the quality, delivery and efficiency of health and care services. People who need access to health and care services can benefit from using technology, for example telehealth (this includes routine monitoring of people with long-term conditions and remote clinical diagnosis) or telecare (using technology to support people to live independently in their own home).

Telecare has traditionally been used to support individuals with a range of health and/or social care needs to live more independently and remain at home safely. Examples include alarms and devices that trigger a response from a call centre, such as falls monitors and motion sensors. These services have been mainly led by councils.

In October 2011, Audit Scotland will publish a report on telehealth. A review of telecare could build on this work and make recommendations to inform the future development of telehealthcare, which brings together telecare and telehealth.  Key audit questions could include:

  • How much is spent on telecare?
  • To what extent has telecare been rolled out across Scotland?(This could include assessment of the variation in approach across Scotland, issues around leadership and direction and examples of impact  from the rest of the UK and from overseas)
  • How effective is spend on these services?
  • What is the impact of spend on telecare? (including reductions in emergency admissions)

Back to top

27. Young people leaving care

Young people leaving care are among the most vulnerable groups in society and are more likely to experience a range of challenges in adult life, such as homelessness and mental health problems, than those with no care background. Many young people leave care at 16 and local authorities and their partners provide a range of ‘throughcare’ and ‘aftercare’ services to help them make the transition from care to independence and improve their life chances. 3, 452 young people were reported to be eligible for aftercare services in 2009, with support including finding accommodation and employment or training, budgeting, and other independent living skills.

In September 2010, Audit Scotland published a report on Getting it right for children in residential childcare. A review of services for young people leaving care could build on this work and consider how well public bodies are working together to improve outcomes for young people leaving care. Key audit questions could include:

  • How much do services for young people leaving care cost?
  • How effective are these services in improving outcomes?
  • How well are services targeted towards young people’s needs?
  • How efficient are services for young people leaving care?

Back to top

How to respond

If you would like to respond to our consultation you can do so in the following ways:

Further information

Audit Scotland helps the Auditor General and the Accounts Commission to make sure organisations that spend public money in Scotland use it properly, efficiently and effectively.
We look across the public sector at central and local government and the NHS.

View our previous reports and supporting information here.