Chamber and committees

I have a couple of specific questions that I do not think require an extensive answer, but which I raise so that it is clear for the record. Kirsty Cumming, you had an exchange with the convener, which I was struck by and that I thought it might be useful to come back to. Last week or the week before, we had evidence from the Scottish Food Commission, which, when discussing the issues of efficiencies and setting targets, was keen to emphasise that different organisations were at different points for a range of reasons. The evidence that the convener picked up on was perhaps coming to that, so I wanted to see whether the Scottish Food Commission’s comments resonated with you.

I will come back to that in a second but I want to be clear on something, so I have a specific question for Helen Malo about the opportunity for the third sector. This might come back to Ian Bruce’s point about how we define public service reform. Helen, I do not want to put words in your mouth but I think that, when you talk about transformational change in public services, you are saying that changing the administrative map of Scotland will not necessarily be what provide opportunities in that regard. I want you to tease that out. Were you saying that you are looking at the wider agenda around outcomes? Is that what you meant?

Other members will ask about prevention later, so I want to broaden out my final question to everybody. The TSI evidence made the point that the £500 million target should be treated as the outcome rather than the driver—we cannot have cuts drive the agenda, and efficiencies must be about delivering a real outcome. All of the submissions, particularly the one from TSI, provided strong evidence about the question of barriers to efficiency and meaningful reform. I want to give you the opportunity to flesh that out, because the submissions contained some good suggestions. We have heard about what you think makes a good relationship with statutory services. What presents a barrier to that good approach to public service reform being taken? What does good reform look like as opposed to something that is just driven by efficiency? I think that there is a danger that we might end up putting the cart before the horse.

We will start with Kirsty Morrison, as she seems to be nodding.

I have a couple of very specific questions. However, on the back of the past couple of questions, I will ask about something that it might be useful for the committee to know and to put on the record. As usual, I declare an interest in that I am a serving councillor who was working on these very issues not long ago.

What is a preferred relationship with the public sector? In a lot of cases, the relationship will be with a democratically accountable local authority. For me, that was about making sure that, when we had a relationship with a provider in the third sector, we knew that that work was commissioned or was part of some sort of framework. I did not want money to leave my local authority without our knowing where it was going and what it was doing. We tried to get to a place whereby that was a two-way relationship.

What does a good relationship look like? I am thinking in particular about the objectives for improving outcomes. What is the framework for the agreement that sits behind that, that represents best practice at a time when there will be a lot of change in public services? I throw out that question to everybody.

Indeed—we do not have a huge amount of time, so I ask witnesses to say succinctly what they think that looks like. Let us start with Kirsty Morrison and work our way along the panel.

The flip side of waiting so late in the day to put that provocation to the previous panel is that a number of the witnesses on this panel heard it and were able to pick up on it. I want to come back to the IPPR’s point that

“If austerity is taken to refer to a degradation of public services in pursuit of balanced public finances, then the current workforce reduction target risks Scotland slipping into austerity.”

What do you think of that? How do you assess that risk? Is there a high risk or a low risk?

Your written evidence gave us some interesting examples of how we can create the space to invest in outcomes, such as paediatric pathways in NHS Lothian and e-prescribing. You also gave some examples of areas in which there had not been such a good use of public resources to get outcomes. You specifically said that, if the evaluation does not stack up, the GP walk-in services will not be not a good use of money and should not continue. Will you elaborate on where the high-impact outcomes that you think we should be trying to get to are within the wider reform agenda? You also mentioned red tape. If we are following the evidence on prevention, what would not be a good intervention in health and social care?

My final question is probably a provocative one, but deliberately so. If you cannot answer it now, feel free to follow up in writing.

Basically, we have spoken a lot today about workforce targets and the apparatus of the state. I want to follow up on the last two questioners because, for me, real public service reform—progressive public service reform—is about tackling the root causes of failure demand. It is about poverty, inequality, and ill health. Is there a fundamental flaw in the public service reform strategy and the documents that sit around it in that we are not seriously creating the space for investment in change because we are being driven by an imperative to make cuts?

I do not know whether you have seen the Institute for Public Policy Research evidence to the committee, which suggests that the workforce reductions risk us slipping back into austerity. We are not going to change people’s lives with more austerity. That is my provocation—have you got any thoughts on it? If you cannot give a succinct response on that today, feel free to follow up in writing.

I am all right to come in after Lorna Slater, because she wants to talk about the workforce.

The last area that I will look at is health and social care reform, so I apologise, Dr Williams, if I keep coming back to you disproportionately, but I am sure that there will be something in the questions for everyone.

You will have seen that the programme for government includes some proposals on the future of IJBs, and we have spoken about the proposed changes to health boards. I am curious to hear your thoughts on how structural change drives better outcomes or efficiencies and perhaps the limits to that approach.

One area that I am keen to discuss is some of the unnecessary barriers that exist when it comes to reform and integration, and I wonder whether you think that we give enough visibility to other issues, such as underfunding or sectoral bargaining. Earlier, you mentioned power of attorney, which is a real barrier in this space, as well as legislation on adults with incapacity and even things such as families disagreeing about what should happen.

I am curious to tease out your reactions to, first, what we have heard about health and social care reform, and, secondly, the limits of the proposed structural changes, as opposed to things that we have heard about in other subject matter, such as actually investing in real social change. I am curious to get some initial reactions to that, and I then have some follow-up questions.