Health and Sport Committee

Meeting date: Tuesday, May 1, 2018

Official Report 496KB pdf

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Scottish Health Council Review

Good morning and welcome to the 14th meeting of the Health and Sport Committee in 2018. I ask everyone in the room to ensure that their mobile phones are on silent. You are welcome to use mobile devices for social media purposes, but please do not take photographs or record proceedings.

The first item on our agenda is an evidence session on the Scottish health council review. This session is a follow-up to a previous evidence session that was held with the Scottish health council in January 2017, which was before my time on the committee.

I welcome—personally, for the first time—Pam Whittle, the chair of the Scottish health council; Sandra McDougall, the acting director of the Scottish health council; and Robbie Pearson, the chief executive of Healthcare Improvement Scotland.

Given the range of witnesses on the panel, it would be useful if we could start by establishing the relationship between the Scottish health council and Healthcare Improvement Scotland.

The Scottish health council is constituted in legislation as a committee of the board of Healthcare Improvement Scotland. As an entity, it is embedded in and is accountable to Healthcare Improvement Scotland. There is an accountability line that runs from the director of the Scottish health council to the chair of the Scottish health council, and a line of accountability that runs from the director of the Scottish health council to me, as the chief executive of Healthcare Improvement Scotland.

That is helpful.

The Scottish health council acts as a governance committee of Healthcare Improvement Scotland. As a result of that, we have a mixed membership. Half of the membership comes from Healthcare Improvement Scotland board members and the other half is separately appointed. At the moment, pending the final outcome of the review, we are considering how we might broaden that wider public membership.

A primary function of the Scottish health council involves enabling public participation and influence in relation to change within health services. Is that role to scrutinise the efforts of others, or is it a support role? Is it perhaps a combination of both?

It is a blend of things. There is a scrutiny role, a quality assurance role, an improvement support role and an enabling role. We can perhaps say a bit more about how we would like to strengthen the enabling of capacity and capability in Scotland and how we want to engage with communities as part of the review.

In some ways, the Scottish health council is a microcosm of Healthcare Improvement Scotland, which has a role in quality assurance, improvement support and the dissemination of good practice and evidence. You can see all that within the Scottish health council itself. We can say more about individual parts of that as the evidence session proceeds.

We have a relatively small team in the Scottish health council that specialises in working with boards and, more recently, health and social care partnerships, in relation to service change. The vast majority of that work is about offering advice on good practice, sharing examples of experience from other areas and conducting a bit of training and capacity building with staff in those bodies.

In a small number of changes that are identified as involving major change, the Scottish health council has a quality assurance role, which means that we work closely with the national health service boards throughout that process. The boards are required to carry out a minimum of three months’ consultation. We have a role in making sure that they follow the requirements in the chief executive letter 4 (2010) guidelines and, at the end of that process, in producing reports that go to the boards to help to inform their decision making before any proposals are made to the cabinet secretary.

In such reports, we try to do three things. First, we set out the process that a board has followed and how that has complied with the guidance. Then we seek to provide an independent summary of any views and concerns that might have been expressed by communities throughout those processes. Thirdly, we think about recommendations for the board in moving forward, including next steps that we think it should take on particular changes, and also areas from which we think it could perhaps learn for the future.

How far do any of our witnesses feel that the function and role of the Scottish health council that you have just described are clear to the general public?

I would like to mention a bit of feedback from the consultation that we undertook. There is not as much clarity as there could be about the council’s role. In some ways, it would be fair to say that its name gets in the way. The evidence that we have given to this committee in the past, about the improvement hub, is a good demonstration of the broader opportunity that we have in Healthcare Improvement Scotland and what we are doing to explain its work. However, we still have work to do to make sure that people understand the role of the Scottish health council within the broader responsibilities of Healthcare Improvement Scotland.

Equally, there is a role for us in ensuring that the Scottish health council is fit for purpose in a different landscape. If we go back to when the Scottish health council was constituted in 2005, there were 15 territorial health boards with which there was a principal relationship. We are now in an environment that is more diverse: we must engage with around 70 different bodies, from local authorities to territorial boards and integration authorities—and that is putting aside where we are with the voluntary sector.

There is still work to be done in defining, very clearly, the role and contribution of the Scottish health council within the broader strategy of Healthcare Improvement Scotland.

I want to explore that a wee bit further. Sandra McDougall, you laid out the two things that the Scottish health council is trying to do and the three outputs from that, which are quite clear in my mind. In your submission, you talk about refocusing and possibly going in a different direction and changing what you are doing. Given your description of what you do, I would like to understand what you think that you should or should not be doing, and what extra you should or should not be doing.

Do you mean specifically in relation to the service change work that we do, or more generally?

In your submission, you say that you believe that a refocused Scottish health council can look at making changes in what it is doing. What do you think you need to change?

I suppose that health and social care integration has been very important for people who use the services and for communities across Scotland. Over the past couple of years, it has changed the way in which we have worked. We do not have a formal role to work with the integration authorities: our statutory role is about working with NHS boards. However, in light of integration and what it means for communities, we have already started to adjust the ways in which we work, following approaches such as the our voice framework, which was about strengthening people’s voices across health and social care services.

Over the past few years, we have been doing that gradually, and have been doing more work directly with communities. We have offered informal advice on service change to health and social care partnerships, which was an opportunity for us to step back and reflect on how the landscape has changed and how we might have to change to adjust and accommodate that. We recognise that that means working with a number of different bodies and working in different ways. Other bodies have a real interest in that, and we want to make sure that our work is focused on the areas in which it will make the biggest impact. That was the purpose of having the consultation.

I understand about your landscape changing and the need to look at social care as well as health. That is clear. You are doing what you were doing, but expanding to work with different bodies. The bit that I want to ask about is a quotation from the review of the Scottish health council. Pam Whittle stated:

“There are undoubtedly tensions between different aspects of the current role of the Scottish Health Council in acting as a ... quality assurance body ... and an emerging call ... to move to being an independent ... feedback body.”

I am not quite sure where that is going.

Independence is quite a difficult issue for an organisation that sits within an organisation, but we do speak as an independent voice. We have become more assertive in trying to ensure that our view is clearer as we move forward, but nevertheless it is a complex picture.

Do you think that you are not independent? At the end of the day, it is the health boards that you are advising and it is the health boards that you are monitoring. Do you think that you are not independent of the health boards?

We are independent of them.

Exactly, so I do not understand why you think that there is tension.

It is a perceived lack of independence, from the point of view of certain people who have thought that in the past. It is a question of us being clearer.

It is a communication issue rather than fundamentally changing anything.

That is correct. It is about communicating what we are about. That is something that became quite clear in the progress of the initial review and the subsequent review. It was not clear to everybody exactly what our role was.

Right, so you are talking not about changing the remit or the direction, what you do or the way you are doing it, but about how you communicate that to make it clearer what is going on.

Yes.

I would like to pick up on a point that was mentioned about what would be different about the Scottish health council, as we evolve over the next couple of years. For instance, the primary relationship between the Scottish health council and the territorial boards is through our local offices around the country. That is an important working relationship at the front line of services out there in Scotland.

One of the other things that I would like to see the Scottish health council do, beyond the local contribution, is to give more of a voice to the bigger national issues facing Scotland. The committee has spent a lot of time looking at the quality of care offered to children and adolescents in Scotland. The Scottish health council could have a role in giving an overall thematic review of how easy it is for individuals, families, children and young people to access child and adolescent mental health services, from the perspective of the user. I would like to see more of that evolving for the Scottish health council in future.

I have a practical question to finish up with. In my area, in the east end of Glasgow, we had a situation with the Lightburn hospital site. Thankfully, that is behind us now. I have met the health board to discuss how to go forward, what was on that site, what was on other sites, and what it will do with services around the area. As part of that, I and other elected members intend to go out and talk to community groups on our own behalf and get some comments and feedback to take to the health board so that we can say, “This is what we have seen in the community.” Is that kind of engagement process, outside of what the health board is doing directly, something that you would be willing to engage with and support us in doing?

Absolutely. One of the discussions that we had at a previous meeting of this committee was about the concern over being in an arbitrary position between major and all service change. Whether we are dealing with NHS boards or integration authorities, we want to enable them to do their very best in engaging with their communities, and to provide them with tools and expertise. That is very much akin to the resource that we provide nationally for improvement support through our improvement hub. I would like more of that to be taken forward through the Scottish health council as it engages in supporting those bodies that are responsible for engagement with communities, so that they can do so in a consistent, high-quality way.

I want to touch on the integration joint boards. Sandra McDougall mentioned giving advice informally, but it is still not clear to the general public or to me exactly what you do and who you are accountable to under the legislation. Should your role be extended to include intergenerational social care and health? Would there need to be legislative change for the Scottish health council to be able to work with the integration joint boards? You mentioned that you give advice, but you do not have any legislative clout. Does legislation need to change so that you can do the job, with the health integration that is coming?

10:15  

The position is that Healthcare Improvement Scotland, of which the Scottish health council is a constituent part, is already engaging with integration authorities. Improvement support around strategic planning and the strategic commissioning of services is a good example. We already work with the Care Inspectorate in the joint inspection of adult services. For example, we just published a report on North Lanarkshire.

I do not believe that there need to be legislative changes. It is about how we work with a broad range of stakeholders, including the Care Inspectorate, Health and Social Care Alliance Scotland, the Convention of Scottish Local Authorities and a diverse range of voluntary groups. We cannot possibly do everything with the Scottish health council’s resources, so it is about how we deploy our expertise and skills with other agencies to support and enable greater participation and the engagement of citizens in the design of health and social care services. I do not believe that there need to be legislative changes, but it is important that we work across organisational boundaries in a way that ultimately delivers better outcomes. That must be the objective.

You do not believe that there needs to be any legislative change, because you are already working with the integration joint boards.

We are already working with them.

You mentioned the groups that you engage with, and at the very end you mentioned the public, who are most important when we are talking about changes. How do you expect to expand your role in working with the public to ensure that people are consulted and know about integration?

There are two parts to that. It is really important to engage with people at local level. I can say a bit more on that, but Sandra McDougall might want to say a bit about engaging with people through the national citizens panel.

We have tried to engage in a number of ways; our citizens panel is one mechanism through which we engage with people on national issues. We also use our local offices and their networks to gather views from people about various issues. There might be examples in our written submission.

The national citizens panel was set up partly because there was a perceived gap. How do we get the voice of the general public in Scotland—rather than that of people who have a particular interest and who might already be involved and engaged—into health and social care issues? Panel members were recruited from across Scotland. Our report sets out the rationale for and the thinking behind recruiting people in the way that we did: we went through the electoral register, we did some on-street recruitment and we did targeted recruitment. The idea was to get a profile that was broadly representative of the Scottish population. We have been quite successful in that, but there were one or two categories in which it was a bit trickier to get people, in trying to strike that balance.

Over the past year, we have tested working with the panel primarily through surveys. We have asked a number of questions, some of which have come from the Scottish Government on policies that it is working on, and some from third sector organisations. We produce and publish the reports, and we are keen for those reports to have an impact. We go back to panel members with the write-up of the findings, so that they can see what is emerging. We also follow up with people who have an interest in the questions and in taking findings forward so that we can feed back to panel members how their views have been used. That is one way in which we engage with the broader public.

A colleague will ask about the consultation process and how many replies you had, so I will not.

There is the national citizens panel, and local people who will be affected by change are also consulted, I hope, by the health board—at least, they should be. I do not mean this in a bad way, but do you think that there is still a role for the Scottish health council? You have said—not just to me but to others—that the council gives advice informally regarding integration, which is a huge issue. You speak to the health boards, and you see whether consultations have gone out, but those consultations are statutory and must be done.

Unfortunately, I had a situation in Glasgow that was similar to the one that was described by Ivan McKee, concerning the minor injuries unit, in which we had to push for things to be consulted on. Is there still a use for the Scottish health council? Have you spoken to the Scottish Government about it?

Sandra White is, I think, focusing on service change. There is clearly still an agenda around service change, the 2020 vision and how we make changes to primary care services, for example. It is important that people in communities are engaged and are co-producing the changes, from the outset. In the vast majority of cases, we seek to add value to the process through offering advice and good practice to boards, by giving examples of what has worked elsewhere and by using our local knowledge and intelligence to suggest groups that might not have had an opportunity to contribute or which might not be on the radar of the health board or integration authority, in order to ensure that as many people as possible have a say. That sometimes also involves capacity building with the boards.

I am sorry to interrupt you. When you mention groups that have not had a say, do you mean local communities?

Yes.

Does that include patient groups?

Yes.

Yes.

Those are the most vulnerable people, who tend not to get a say. I will not go into how many people have replied in that group, because I know that it will be asked about. Is it your purpose to get hard-to-reach people to come to you?

Yes—absolutely. In the case of major change or changes that are regarded as contentious, our report’s value is in that we provide independent commentary and independent assurance—we hope—about how the process has been followed. We also provide an independent summary of the views and concerns that have been expressed by communities, and where we think the board can learn. We hope that that is of value in informing the decision-making process.

In the light of the major questions that have arisen from the review regarding the Scottish health council’s existence and role, can you tell me what material actions and decisions have resulted from that lengthy review?

We have received the review and are considering it. Over the past two months, we have been taking the outputs from it.

There are four or five big things that we want to do on the back of the review. First, we must respect that we no longer have 15 territorial boards, as was the case in 2005; there is a completely different landscape in health and social care. I will not dwell on that any longer, but we need to adjust to it.

Secondly, people are looking for us to influence and inform policy at national level. I have touched on how children and adolescents in Scotland access services. We know that half of adults in Scotland with a mental health condition acquired the condition before the age of 14. There is an important role for us in the Scottish health council and Healthcare Improvement Scotland in informing the design of services and in informing best participation and practice in terms of people accessing child and adolescent mental health services. That is one area where I would like us to adopt a national thematic approach.

The third point that has been identified from the consultation is that there is lots of good practice in, evidence about and toolkits for participation and engagement. However, implementation is pretty patchy. We have a greater role not only in quality assuring but in providing tools and in enabling more consistent capability.

The fourth area that has come out of the consultation concerns service change. There is an absolute need for clarity regarding the role of the Scottish health council in the more integrated landscape. We can say a bit more on our thinking about how we convey that.

Those are four big themes that are emerging from the review.

Another message is a positive one about the contribution of Scottish health council staff at local level through the supportive relationships that they have built up with NHS boards over the past 12 years or so. We also recognise that there is a need to enhance capability and expertise in order to allow greater involvement in the design of effective participation. That requires enhancement of skills and resources in the Scottish health council to build on our local presence. Those are resourcing issues, so we need to think how best to do all that.

I hope that that gives you a flavour of the key messages that are emerging and how we anticipate responding.

You say that that is how you “anticipate responding”, but I took a note of what you said. You identified areas where the Scottish health council might need to change, but you did not explain how. For example, you said that you would like to influence policy, but you did not say how you would follow that through. You said that you need to adjust to the different landscape of health boards, but you did not say exactly how you will do that. Can you enlighten me a little on that?

This will be a transition and a journey. The Scottish health council has existed since 2005, so we cannot just flick a switch and achieve all those things. There are issues with resourcing, the workforce, skills and how we work with a range of partners to deliver what we deliver.

We have had good working relationships with the Care Inspectorate, the Health and Social Care Alliance Scotland, and the Convention of Scottish Local Authorities, and it is important that we build on those. It will be a two-year to three-year journey.

On the specific point about thematics, I meant that Healthcare Improvement Scotland will in the future publish a report about access to child and adolescent mental health services, for example. That would cover individual young people, their families and their mums and dads. It would cover how they were able to access the services—how easy it was and what the difficulties and challenges were—and how we can better inform more effective participation.

I will describe a bit about how things have worked and how that might change for our staff on a day-to-day basis. A lot of requests come into the organisation locally and nationally for support. They are requests for us to get involved in a range of things; providing advice, perhaps, to somebody who is reviewing a service, providing training and so on. We have multiple activities going on across all our work.

We need to focus on areas where we can make a bigger collective impact, so that we join up some of the work that might be happening locally with our evidence function at national level, and with our volunteering programme, where there is a role for volunteers in a particular activity. We want to move in the future to a system that means that, rather than responding to all the different demands on us, we engage with our stakeholders and consider priorities for services, and where our collective effort might make the biggest difference.

That is what we mean when we talk about shifting to a more thematic way of working. We want to do that more collaboratively with our stakeholders to ensure that we avoid duplication, that we add value and that we can demonstrate a distinct impact. We want to ensure that we look for opportunities to collaborate with others when our collective effort might add the biggest benefit.

I hope that that articulates what the shift might look like for our staff and what we deliver each year.

One of the interesting developments in the past year was my establishment of a programme board for taking forward aspects of the “Our voice” programme for which the Scottish health council is responsible. That brought other people into play in a much closer partnership approach that has demonstrated how we are moving forward jointly with the Health and Social Care Alliance Scotland and COSLA. It has been very positive. We want to build on that type of partnership approach, and to do it on a bigger scale.

If you go to a more national model of working, what will be the implications for the local engagement that colleagues have asked about?

It is crucial that we do not throw the baby out with the bath water. The relationships with local offices are absolutely important. However, there are 31 integration authorities, 32 local authorities and three emergent regions, so we need to start to think about how we evolve our relationships beyond where they have traditionally been on the spine of 14 territorial boards. That will require different thinking about resources and how we use our people to best effect.

10:30  

We have a budget of about £2.7 million and more than 60 people. We have some people who are extremely experienced in the work that they have done and the relationships that they have built. We need to be careful that we do not move towards a centralised system; that is not what this is about. It is about a balance between local identity and local presence and adding value at national level, where appropriate, by doing bigger national things. There are choices and priorities to be made within that balance.

Good morning, panel. Following up on questions from Sandra White and Ash Denham, I want to look at how that will happen in practice. At our last meeting with the Scottish health council, our former convener read out a quote from one of my constituents, who believed that the SHC was a “toothless beast” with absolutely no power to enforce recommendations. How will your review change that for patients who are trying to put their faith in your organisation to speak on their behalf when major service changes take place? Is it time that we looked at whether there should be more of an independent role for the SHC?

It would be fair to say that we in Healthcare Improvement Scotland do not pull our punches when we do our scrutiny work. We are very direct in how we convey some tough messages. There are some points of learning and reflection that we want to take from the service change process that we think will enhance our contribution from a participation and engagement perspective. Sandra McDougall might want to refer to that.

It is a good question. We realise that people feel passionate about major changes, and that such changes can involve quite lengthy and protracted processes. People invest a lot of time and effort because they really care about the services that are being considered. What we have in common with those people is that we want to ensure that their voices are listened to and that that is evident in the decision-making process in NHS boards.

I have alluded to the fact that, as well as looking at the process for engagement, our reports seek to provide an independent commentary on the views and concerns that have been expressed by communities and on recommendations. We speak to communities directly through those processes. If campaign groups are established, we are keen to ensure that we understand and reflect their views in our reports. However, our report is produced prior to the board making its decision. We send our report to the board for it to take account of.

An interesting suggestion in the consultation responses that we received was whether boards could respond more formally to our reports and recommendations. We would welcome that and it would probably be welcomed by the communities that take part in such processes, because it would enable there to be a clear articulation of how the boards take people’s views into account. That might not necessarily mean that the board agrees with the views and concerns of the people who have been involved, but boards need to be able to respond to people and explain the rationale if they are proposing something that is at odds with what communities want. That part of the process, and getting it right, is really important.

To get to the nub of the matter, we should look at what Nicola Sturgeon said in 2002 when she was a member of the Health and Community Care Committee. She said:

“People feel that consultation processes are a sham; the health board goes through the motions then does what it wants regardless.”—[Official Report, Health and Community Care Committee, 22 May 2002; c 2746.]

That sums up our concerns. Your recommendations are just that—they are recommendations. Health boards can, and do, ignore them. When people are running a campaign, using your organisation to help them stand up is really important. I have not heard how you think that has to change to ensure that your recommendation not to go forward with service change, for example, is heeded and not just considered by health boards.

The Scottish health council’s role is to quality assure the level and quality of engagement in making sure that voices are heard when there is major service change. Our role is not to provide a commentary on, for example, the overall shape of the clinical model that has been advanced. Sandra McDougall has described a process that would be more transparent about how the board has responded to our recommendations about participation in the context of quality assurance. That would be similar to the role that Healthcare Improvement Scotland already has from the scrutiny standpoint about the recommendations and requirements for NHS boards. There would be a level of transparency in the responsiveness of NHS boards.

My question stems from that of Miles Briggs and touches on the granular detail of service redesign, which has been covered lightly so far. The Scottish health council’s function to consult about major service redesign was discussed by the committee last year, and I ask panellists to remind us how a service redesign is designated as major or minor. If a service redesign is minor, what is your mandate with regard to consultation with the public?

I think that that question is for Sandra McDougall.

The process is set out in the chief executive letter 4 (2010) guidance for NHS boards. Boards are required to consider whether a service change should be designated as major and to seek advice from the Scottish Government if they think that it may be. The approach to the Government has to take account of the guidance on identifying major change, which sets out nine factors to ensure that the consideration is full and comprehensive. The factors include the impact on patients and how many are likely to be affected; whether a relocation or centralisation of services is involved; whether it involves unscheduled or emergency care; any public concern so far about the proposals, based on engagement that has taken place; the likely impact on other services; and any particular history of the service.

The board should consider the guidance to reach its view on whether the change is major and, if so, approach the Scottish Government. If it does that, it has become custom and practice for the board to ask for our view to include in its approach. We take into account the board’s consideration, our knowledge and understanding of the process and the concerns that have been expressed so far. We look at precedents, such as whether any similar changes that have been considered in the past were considered to be major change. All those views go to the Scottish Government, which ultimately makes the decision on whether a change is major.

It is unfortunate that the approach has become perceived as two tier—major versus non-major—because, from our perspective, it is important that the guidance and process are clear and that people are involved from the outset to help to shape the change, wherever the decision is to be made. We appreciate that whether the status of a change is major has become very important for some communities.

If the Government designates a service change as minor, does the Scottish health council have any role in consulting affected communities?

We do not have a role in consulting communities, as that sits with NHS boards. Our role for major changes is to provide a quality assurance report about how the board has consulted, and we speak directly to communities to inform our view. When the change is not major, our role is to advise on what engagement might be proportionate and we share practice from other areas for boards to take into account when planning changes. We still encourage boards to make sure that their communities have every chance to give views on processes from the outset and that boards take those views into account. However, we do not have a formal role on quality assurance of non-major change.

Given that any service change can be very emotive for the patients it affects, the subjective application of the guidance can be quite troublesome. It worries me that the Scottish Government is the final arbiter of that decision, particularly when it is facing negative public scrutiny about the proposed service redesign. Do you agree that that decision should perhaps be taken away from the Scottish Government and that designation of whether change is major or minor should rest with yourselves or another third-party body?

I do not think that it is appropriate for me to comment on whether a decision at that level should be taken away from ministers. Ultimately, the accountability of ministers for major service change in the national health service rests with the Parliament. It should remain with ministers; I am not here to comment on that. What is important for the Scottish health council is that, whatever the nature of the change, we ensure that there is best practice and effective participation. I very much take the point that has been made that any change, whether it is major or less than major, matters to communities.

Absolutely.

Good morning, panel. I want to follow on from Miles Briggs’s question. He said that HIS reviews and SHC reviews are recommendations and there is no compulsion to take them forward. Who has overview of the implementation of the recommendations? Robbie Pearson and I both know that an HIS review in 2017 was almost identical to the one that came out in 2012, which contained recommendations that have not been implemented. Should the implementation of recommendations be policed by yourselves? Should the effectiveness of the implementation of recommendations be published? At the moment, boards are self-reporting on the recommendations. Should HIS and the SHC have a bigger independent role in policing that change?

That is an important point. To pick up the point that Sandra McDougall made, I would like there to be transparency around the recommendations that arise from major service change to ensure that NHS boards do not just add recommendations to the business case and then off they go. We need to ensure closure of the loop. When there are concerns—whether they are about a community’s access to transport or the distribution of a service that is perhaps moving in a different way—those voices should be heard and there should be an active feedback loop from the issues that have been raised in our work and the recommendations that come from it. That is an important part of the role of Healthcare Improvement Scotland. The patients who are at the centre of our work are important. The voice of citizens in accessing health and social care services needs to be absolutely to the fore. There is a point about transparency in ensuring that NHS boards respond to recommendations in a very clear and meaningful way. It should not be about tokenism.

In that case, who is reviewing and publishing the implementation of recommendations? How will you make that more transparent?

Sandra McDougall has described the process whereby we make recommendations on the basis of a process of engagement and participation, which might have been good, suboptimal or poor. We make recommendations, but we need to ensure that NHS boards respond visibly and publicly to such recommendations in the future. That would be a good step forward for transparency and for building a more effective system of responsiveness among NHS boards.

Does HIS need more legislative power to implement that?

I do not believe that we need more legislative power.

Good morning, everybody. I am interested in what has been done differently in the past year from the previous report to engage locally. Looking at the Scottish health council’s website, we can see that there are documents and documents and documents—it would take me days to go through them—which are all excellent, but I have been a nurse for 30 years and I did not know that the health council existed until I joined this committee. I have also spoken to former colleagues who would be happy to engage. My question is about what the Scottish health council has done differently. Sometimes, local people are informed by social media action groups instead of by boards that are communicating more effectively. Is the Scottish health council able to support boards to engage with local people?

10:45  

A key part of our role is to support boards and to encourage them to do more. Some boards are moving forward differently, and methods of communication change all the time. I accept your point that workers in the health service do not always know about the council. We have had positive social media action and are quite prolific on Twitter, but our visibility might not have been as clear in the past.

A relatively new development for us has been the “Voices Scotland” approach, which builds capacity with community groups that might be interested in more involvement and broadens the reach and diversity of people who are involved at a local level. Chest Heart & Stroke Scotland developed this flexible, modular approach to support and enable groups to understand the structure of local services and how they work. The approach encourages people to think about their experiences of services, what matters to them, whether they might like to see change and how to go about having their voices heard locally. Our local staff have been trained to deliver the approach, which they are using flexibly with groups to encourage bottom-up engagement, so that bodies respond to the issues that matter to people, rather than just consulting on the issues that they want to consult about. It is about trying to encourage confidence in communities, and it has been received pretty positively by the groups that we have worked with.

It takes a long time to push forward change in the national health service, as it is slow and people have to join together. How do you decide how to do consultations? The consultation on organ and tissue donation and transplantation has no input from anybody in the NHS Dumfries and Galloway or NHS Borders area, but there is input from NHS Ayrshire and Arran. South Scotland is a huge region; how do you decide who to engage with locally?

Our gathering views work usually responds to requests from the Scottish Government or other bodies. We have the advantage of a national presence and local reach, so we can use our contacts and community experience to engage with people in a targeted way, based on our conversations with the people who ask us to consult on their behalf.

For the consultation on organ and tissue donation and transplantation, work had been done and other engagement was already planned, but a need was identified to engage with particular groups, such as people with learning difficulties and looked-after children and young people. Tissue donation and transplantation has particular legal issues about consent for those groups, which is why the activity was intended to be targeted. We worked with Barnardo’s Scotland, People First (Scotland), the Arran Youth Foundations and others to design a session to get the views of people with learning difficulties and looked-after children and young people, so that their voices would be heard on those important national policy issues. The targeting depends on the ask, the target audience that people seek to reach and which local organisations we might collaborate with to enable that to happen. Does that help to clarify the local engagement?

Sure.

That was helpful; thank you very much.

I have two very brief questions. First, in a word, are boards engaging better or worse with the public?

I am not sure whether it is a binary answer. There are demonstrations of good practice in engagement around the country, but there are examples of pretty poor practice, too. Healthcare Improvement Scotland—and the Scottish health council, in particular—need to bring to the surface the really good practice. Equally, there needs to be transparency about where there is poor practice. That is how we will get engagement of a much higher quality across the country.

Secondly, I note that in 2016-17 boards were largely focused on feedback, comments, concerns and complaints when it came to engagement, which is very much retrospective. Can you give us an example of a board that has done a good job in engaging with the public in a way that is bigger and broader than just feedback on complaints?

We did some work specifically around feedback on complaints that used our participation standard, which was about going out and looking at how boards are responding. There was a bit of a mixed picture. To clarify, are you looking for an example about broader engagement?

I will try to keep it quick. In your reports, how do you identify how boards are engaging with the public generally and whether they are meeting the three participation standards? I note that in 2016-17, the boards were focused largely on complaints and so on. Did you look at the other participation standards? Was there a particular board that stood out in terms of how it was doing that?

During the recent assessment we looked only at how boards were handling complaints and feedback. That was on the basis of expectations in the Patient Rights (Scotland) Act 2011, which were about looking at complaints and feedback in a much more holistic way—not treating them as separate things, but looking at all the intelligence and ensuring that there are lots of different opportunities for people to give feedback, through things such as Care Opinion for example, and that people have access to the patient advice and support service. The participation standard assessment that we did was focused very specifically on that area of boards’ responsibilities. The process this year showed that some boards have made real improvements since a couple of years ago, which was when we looked at the issue previously; other boards had shown less improvement. There is a national overview report that sets out our findings on that and pulls out examples of good practice from a number of different boards. It is a really important area for patients and carers.

Thank you very much. We have had a very full session in a short and compressed period of time. We are very grateful, and I thank our witnesses.

10:53 Meeting suspended.  

10:59 On resuming—