We are grateful for this opportunity to speak to you. I am sure that you have all managed to read the petition, so I will not go over what it says but will simply move on to the key points that arise from it.
As you know, the petition concerns the guidance for changes to health and social care service delivery. The guidance on informing, engaging and consulting people in developing health and community care services is in chief executive letter 4, which was issued in 2010. The guidance therefore relates to the period before the integration of health and social care and the existence of integration joint boards, which means that it refers only to NHS boards. It therefore allows integration joint boards and health and social care corporate bodies to dispute the legitimacy of the guidance. The spirit of the arrangement is that the guidance’s legitimacy should be accepted, but the fact is that the arrangement gives those bodies the chance to object to it.
I want to point out one or two things in the guidance. Clause 8 of the guidance refers to bodies that no longer exist in local areas—they certainly do not exist in Argyll and Bute. I think that the names have been changed and new bodies have been created. Again, that leaves scope for people to be missed out.
Clause 14 in the guidance states that the Scottish health council does not comment on clinical or financial issues. Therefore, if a board decides to treat a change to service delivery as a clinical or financial matter, it can exclude the SHC from comment. In the case of Argyll and Bute, a financial plan was created last June that dealt with the eviction of 12 people from a care home within six months. There seemed to be no need to involve the SHC in that decision, despite the fact that, under any circumstances, kicking 12 people out of their home surely constitutes a major change.
Equally, if a board prepares a plan that has 68 individual actions in it to save a total of £8.5 million, it seems that, because each individual action is a minor change, the sum of all the parts is also viewed as minor. However, I think that a saving of £8.5 million should be viewed as the result of a major change, and major changes need to be considered by the SHC, so the boards know how to go about their consultation processes and their engagement and communication work. In our case, we are eight months beyond the point at which a decision was made, and the SHC has not made a decision. It seems to me that there should be some way of dealing with these matters.
I have made two very specific points, but they indicate the difficulty that the SHC has in balancing its co-operation function and its monitoring function in relation to the work of the boards. These examples show that the guidance needs much more clarity in respect of that relationship. That would be particularly helpful in a situation in which the board does not consider a change to be major but the community stakeholders do. If the kind of change is not identified beforehand, things move on and there is a process of engagement, but it is then too late for the change to become a major change. Whether something is a minor or a major change needs to be resolved prior to any decisions being made by boards.
I will say a little bit about how the boards should communicate and engage with communities. The guidance allows boards to develop their own processes. That is fine, but it would be helpful if the guidance compelled boards to publish details of their communication and engagement process. In some cases, there will be bodies such as ours, which are not normally involved in the engagement process but have an interest in specific issues. If process information was included, we could apply for inclusion, rather than being excluded from the start.
Finally, I make the point that boards that behave in a proper manner do not really need guidance, because openness and transparency happen quite normally. However, in the case of boards such as the Argyll and Bute IJB, which failed in that regard last June, guidance is required, and that guidance must be clear and definitive in order to ensure compliance.
We are concerned not only about Argyll and Bute. This is a new set-up for the integration of health and social care, and there will be other integration joint boards throughout Scotland that will run into the same problems.