Our final agenda item is an evidence-taking session with the Cabinet Secretary for Health and Wellbeing on the Public Bodies (Joint Working) (Scotland) Bill at stage 1. The cabinet secretary has been joined by the following Scottish Government officials: Kathleen Bessos, deputy director, and Alison Taylor, team leader, both from the directorate for health and social care integration. John Paterson stays with us from the previous session.
Thank you for the opportunity to discuss the Public Bodies (Joint Working) (Scotland) Bill. I will take a few minutes to say a word or two about the bill.
Thank you, cabinet secretary. Gil Paterson will ask the first question.
It is safe to say that the oral and written evidence that the committee has received so far shows that there is unanimity across the sector that integration is a good thing that people would like to see happen. Officials may correct me, but I do not think that a single submission has said that integration would be a bad thing. However, there are some ifs, buts and maybes. It has been suggested that the reason for failures in the past has been a lack of good leadership—that seems to be one of the key factors—and that there is a need for cultural change. Given that we are hearing from everybody who is involved that integration would be welcome and should happen, why is there a need for legislation? Why not just let it happen?
Many attempts have been made to make it happen. It has happened in one or two areas—West Lothian is the most notable example—but without statutory underpinning it has not happened. In one or two areas there is still, frankly, resistance to the proposals. We cannot deliver the quality of care that we require to deliver to our adult population—in particular, the disabled population and older people—without the full integration of adult health and social care services.
I am grateful for your answer, but it leads to another question. If people are saying that the problems were due to a lack of leadership, where is the provision for good leadership? Or is that an excuse and are people protecting their empires?
Leadership is part of the equation. It is part of the jigsaw of making it happen, and we are providing leadership at the national level through the bill. I have spoken to Iain Gray, a former minister with responsibility for social justice, and he told me that he regrets the fact that he did not underpin the plans that he had at that time with legislation. Without the legislation it will not work, but the leadership tends to pull the other way because of the vested interests of local authorities and health boards. The bill will ensure that the leadership must pull with integration in both the health boards and the local authorities. In the body corporate model or the lead agency model, the leadership comes from the chief accounting officer or the lead agency. Therefore, the bill will ensure good leadership at the national level as well as at the local level.
We have made it clear from the beginning that legislation in itself will not change the mindsets of the practitioners on the ground and create the leadership. Alongside the legislative work, we are undertaking a significant piece of work on strategic workforce development; I can say a little more about that, if you would like. For us, strategic workforce development plus the work to support locality development and strategic commissioning is where all this will land—or not land—appropriately. The strategic workforce development group will produce, probably by the end of October, a framework for action that will cover the issues that the member has raised around the support for organisational development; the support for the joint boards regarding culture, language and communications; and the support that chief officers will need to provide the strategic leadership that will be required in a complex situation.
I will just add a point about the areas where integration is already happening, such as Highland. A few months ago, I was up in the Royal northern infirmary in Inverness, where people who previously worked with the health board now work with the local authority in an integrated setting. Some of them admitted that they were a bit sceptical, but they now say that it really is the right way to go. I have found many examples of that where integration is already working on the ground.
To be honest, I am not entirely sure that leadership is the real question. There are some real good people, but they have not engaged.
I think that it varies between different areas.
In business or in local or national Government, there are always vested interests. I do not think that we can ever take vested interests out of the equation—that is just the way that it is. People protect their budgets and their own wee areas, or big areas for that matter. Do you agree that, in effect, the bill will mean that the vested interests will get much wider and will encapsulate a much greater area? The sphere of influence and vested interest will encapsulate most of the population. Perhaps I should not say that, but that is what I see in the bill and it is my interpretation of what you are trying to achieve.
We certainly want to ensure that everyone has a vested interest in delivering what will be the national outcomes. It is clear that, whether we are talking about strategic commissioning, budgetary procedures, how the constitution of the bodies is established or reporting mechanisms, we are trying to ensure that everybody’s vested interest is in providing the best possible service to the end user.
We know that you are having discussions with the Convention of Scottish Local Authorities. You might want to bring us up to date on those discussions but, to summarise—I am not saying that this is how it is, but it is how I view it—COSLA says that you are taking wide powers without our knowing how you would use those powers and the circumstances in which you would use them. COSLA’s fear is that you are taking all these powers, but there are no rules of engagement.
The first thing to say is that, although I am called the Cabinet Secretary for Health and Wellbeing, I am also the cabinet secretary responsible for adult social care, so it is just not the case that there is a conflict of interest, because I already have responsibility for adult social care. I exercise those responsibilities today and my predecessors exercised the same responsibilities.
I am sure that you understand that, in the evidence that we have taken, people have been all on board, as Gil Paterson said.
Yes.
Indeed, the committee is on board, but a specific example is the contention about the shifting budget. The evidence that we have heard is that we can put everything in place, legislate and enable. However, according to COSLA in particular, if we do not shift the budget from the acute sector into the community, the approach will not work. I think that your position on whether you could deliver substantial money would be tested at that point, given that what was wanted was a top cut of money from the health service into the community. That is a difficult call for the Cabinet Secretary for Health and Wellbeing.
There cannot be a simplistic percentage cut in the acute budget that is then redirected. That is not the right way to plan ahead.
So you agree with COSLA and others that one of the key aspects is to shift the flow of people and budgets from the acute sector into the community.
That is one of the things that we want to achieve, because we know that people are being hospitalised far too often. If the resources were available in the community, those people would not need to be hospitalised. Let us look at the economics of that. On average, it costs £4,600 a week to keep somebody in an acute hospital in Scotland and around £300 a week to treat a person at home. For those with serious chronic conditions, the average is probably nearer £800 or £900. It makes economic sense to treat people at home, but the really important point is that, where that has been done, patients’ health outcomes have substantially improved. That is particularly true for older people. One of the worst things that we can do is to hospitalise them unnecessarily. We are all at one on that.
Some of us were in West Lothian yesterday. The question is one of widening the integration agenda. It is clear that they are working on adult health and social care, but they were also talking about how important housing and children’s services are. How does that tie in with what COSLA is saying to you about restricting integration?
We are talking about the core of the joint board. The voting membership of the joint board in each local authority area that has the body corporate model will be made up of equal representation between the health board and the local authority. If the board decides that it wants to co-opt non-voting members on to the board, it will have the right to do so. There will be a host of infrastructure around the board and that is where services such as housing will be heavily involved—housing has a particularly important role to play in locality planning. The secondary legislation and the guidance will spell that out in more detail.
What Kathleen Bessos said about the wider agenda is very important. All the witnesses have said that structural change in itself cannot deliver what is required. Most witnesses, with the exception of the Chartered Institute of Public Finance and Accountancy, have gone along in general terms with what is in the bill.
I will get Kathleen Bessos to explain the exact mechanics of how things will work. It is important for people to understand the detail of those mechanics.
I understand that—but some people have expressed concern about that.
A key point of this whole exercise is substantially to increase acute care in the community. If we were not going to give the joint boards some responsibility for the acute budget, that would defeat that particular purpose of the integration agenda.
That is right. The important thing is that we stick with the principle that the resources that are associated with the functions that are delegated to the joint board go with the functions. That is the important point, and that can be clearly articulated. The key question then becomes which aspects of acute resources lend themselves to being used in a different way. Clearly, there are services such as neurosurgery that do not lend themselves to being redesigned to support an improved pathway of care, particularly for older people.
It would be helpful if some of that detail could be provided to the committee and made available more generally. It has become one of the main points of interest in the discussions and I know that there is concern about it in some health boards, so I could probably ask lots of follow-up questions. One basic question might be whether the decision about how much money is in scope is a decision of the body corporate or a decision of the health board. There is lots of scope for tension between those two and I suppose that the general point, as everybody knows, is that even in shifting the balance of care, because of demography, it is not as if acute budgets can be decreased in absolute terms. There are so many questions around that.
The key tool is the strategic commissioning plan. Let us take COPD as an example, and let us say that it is for Edinburgh, Malcolm Chisholm’s area, because the health board and the council have signed up to the scenario. Part of the strategic commissioning plan is to treat far more COPD patients—a percentage might be specified—in the community. To provide that service will require not just GPs, but acute consultants to work in the community. The pace at which it is done, the resource allocation and the way in which it is done should all be part of the strategic commissioning plan, which must be drawn up by the joint board—obviously, Edinburgh is a body corporate model—in wide consultation with not only the health board and the local authority but a range of other bodies. The requirement for a consultation group on the strategic commissioning plan is in the bill. It is not a case of a unilateral decision being made. Everything must be done in consultation with the key stakeholders and then, once the plan is agreed, everybody is signed up to it.
To pick up on a technical detail, the bill sets out that the original agreement between the health board and the local authority, which the bill describes as the integration plan, sets out the functions and the method of calculation for payments to go with the functions in the integrated arrangement. Therefore, at the overarching level—the level of the framework about which the cabinet secretary has been talking—the health board and the local authority will have that initial discussion within the parameters of what must go in, which will be in regulations. Then, once we get into the mechanics of working out how to improve outcomes, it is exactly as the cabinet secretary said: the determination comes into the strategic planning process.
That is fine for the management of a particular condition such as COPD, but when it comes to the more general question of shifting the balance of care and reducing emergency admissions, it becomes a bit more difficult. It would be helpful to have some more detail on that.
I will be clear. The chief officer will be appointed by the joint board. He or she will report to it. That person will not be able to make unilateral decisions; they will be answerable to the joint board. They have to be employed by the local authority or the health board for a host of other reasons.
The view has been expressed that the policy intention has not been translated into the wording of the bill. We will have to consider that at stage 2.
We will do that.
That is right. We have a human resources technical working group considering the matter. The comment has been made—and we have registered it—that the chief officer will be accountable to the joint board for developing and delivering the strategic plan. However, they will have an operational line to the two chief executives for the operational discharge of that responsibility. We will do further work to clarify that, because it is a legitimate point.
We are considering whether we need to lodge an amendment at stage 2 so that there is no dubiety on the issue.
That was an interesting exchange. I have a wee parochial comment on it. I am concerned about the answers about the flow of acute budgets coming from non-specialist hospitals and worry about the sustainability of local hospitals that provide acute services. It seems that that will be the focus of drawing some of the budget out. I might be wrong, but I note the concern.
I say again that I welcome the intentions and objectives of the bill. Yesterday, I was fortunate enough to be part of a delegation that visited West Lothian, and I was impressed with what is being done there, including in the local hospital. I take on board the comments that you made about that.
There is a specification that, for example, there should be a representative from the staff side and a representative of the public, but there is a wider question about the accountability of the bodies. We have a piece of work going on to look specifically at how we can enhance the accountability of not just the health service in general, but the integration joint boards in the future. We do not think that we need to do more on that in the bill, as we believe that we have all the powers that we need. If we need to do anything by way of secondary legislation, we will do it. However, as I said, we are looking at the wider issue of accountability to ensure that there is genuine public accountability.
I welcome that comment as I believe that they should be involved.
I point out that it is not an enabling bill of the kind that has been introduced in previous periods of history by other regimes.
My last question is on VAT, which you will have heard me ask earlier. Different arrangements for VAT apply to local government and NHS boards. Do you have any concerns about that? What work is being done to ensure that no extra VAT will be paid once the bill is passed?
We are in a state of advanced negotiations with HM Revenue & Customs on that very issue. Although I cannot forecast exactly what the outcome will be, I am reasonably confident that we will hopefully end up in a position where there will be no VAT implications in terms of additional expenditure arising from these measures.
I certainly agree with that comment.
I think that Bob Doris has a supplementary question on that.
Mr Lyle used the expression “top table”, and I think that the cabinet secretary gave a hint about this in an earlier answer when he mentioned locality planning. Is there any information available on who would sit at the table—let us call it a wider strategic table rather than a top table—to sign off strategic plans? There has been almost an expectation that various other bodies might sit at that table—I will not list them, because any that I miss out will take it as a slight that they are not considered as strategically important as the others. Who might sit at that wider strategic table and who will have voting rights?
As I said earlier, the key thing is the strategic commissioning plan, which will determine exactly what each board will do. That is one area in the bill where we have been quite prescriptive both about the consultation group that must be set up and about the people who need to be involved in the development of the strategic commissioning plan. Clearly, I would like the process to be as much bottom-up as it is top-down because the strategic commissioning plan should be largely determined by the adult health and social care needs of the community.
As you can see from the bill, we have not set out a prescriptive process on locality planning. That is in direct response to what we were told by stakeholders and partners, particularly those who were already doing something like locality planning well. It would be difficult to find two examples that are particularly similar, as there is huge local variation in how locality planning works, who exactly is around the table—that can depend on the balance of local need—how often they meet and what sorts of decisions they look at. The onus was very much on us to encourage the development of local innovation and not to be prescriptive.
Will there be guidance on local engagement?
Yes, absolutely. I apologise, as I should have said that.
Regarding the wider strategic plan, although other bodies are not mentioned on the face of the bill, I understand that the bill is not restrictive. There is nothing to stop joint boards co-opting other partners on to the board, perhaps without voting rights, for example.
I think that a good comparison can be made with the process for going for planning permission to build a new building. There are statutory consultees, who absolutely must be consulted, but developers must also show that they have consulted the wider community. The process will be similar. There will be statutory consultees, but that is the de minimis position.
Will there be best practice guidance on that?
Yes, there absolutely will.
There is guidance about strategic commissioning, from which we are learning a lot of lessons. We will produce guidance on the bill that builds on what we have learned.
That is helpful, thank you.
In evidence, we have heard concern about matters such as governance, finance, audit, staffing and sharing information—the list goes on and on. How can such issues be satisfactorily resolved?
That was a long list. I think that some concerns are misplaced. For example, I am sure that we will reach agreement with COSLA on amendments at stage 2 that are needed to address its concerns about governance. It was never our intention to give me wide-ranging powers over local authorities beyond what is intended in the bill.
I will be more specific, because I think that you have already made those points. There are different criteria for audit in local government and in health—there are internal and external audit processes and the like. What will the body corporate’s audit function be, and how will it carry it out? What will it need to put in place?
Audit Scotland is part of a group that is looking at the bill, so there is active involvement from Audit Scotland on the issues that might need to be consulted on. The audit trail will need to be clear, so that we know what happens after the money goes into the new organisations. We need to know how the money is being spent and whether it is being spent on the right things, what the approval mechanisms are and so on. The audit process is part of that. Alison Taylor will explain the mechanics of how that will happen.
We have an overarching integrated resources advisory group, which is looking at all aspects of the finance and accounting procedure that relates to what we are proposing under the reforms. Sub-groups are looking at specific topics, such as audit.
Does the same apply to staffing? We have heard evidence that there are different legal requirements for interaction with staffing and training. How will that work in a body corporate that is made up of two legal entities?
I will get Alison Taylor to answer some of the detail, but let me just begin with the principle, which is that the body corporate itself will not be employing people. Obviously, that may change through time, but what we envisage is that, to start with, the people who work directly for the body corporate, such as the chief accounting officer, will be seconded from the local authority or the health board. The reason for that is that, as you will know, employment law is very complicated and it could raise a lot of issues that would make the whole integration process unnecessarily complicated. Therefore, the wisest thing to do at this stage is what we are doing, which is to work on the basis that people will technically be employees of the local authority or the health board, not of the body corporate.
But that will surely require more work. If someone is seconded to the body corporate but kept on the local authority payroll, who will do their local authority work when they are doing the new job? Do you understand what I am driving at? There is a cost involved that is not covered in the bill, and there is no additional funding for it.
In terms of the joint accounting officer, his or her salary and associated costs will obviously be met out of the integrated budget.
It will be jointly paid for by the board and the council.
Obviously, bodies can make their own arrangements, but if the local authority or health board seconds somebody to the body corporate, it will do what it does whenever it seconds anyone, which is to make the necessary arrangements for somebody else to do the job that the person was doing, if it still needs to be done. That is normal procedure.
That would surely mean additional costs for covering for backroom staff, which would take away money from front-line services.
No. The person being seconded will do a job that will have previously been done by the local authority. It will be the same job, but it will be done under the aegis of the joint board.
Let me just pursue this. For example, an HR officer who works for the local authority may be seconded to the new body. They will have done work for more than one department when they were part of the local authority. That work will surely need to be covered by somebody else, which will mean an additional cost.
To be honest, I think that, to start with, that kind of central service will still be provided by the local authority and the health board, because the people working under the aegis of the body corporate will still, as I said earlier, be employed by the health board or the local authority.
Okay. To take the example that you gave earlier of acute clinicians going out to work in the community, could somebody work in the community beside a social worker or care worker and have a different chain of command, line of management, personnel officer and pay structure?
The chain of command for the job that they do will be with the body corporate. Obviously, there is a wide range of pay structures and pay scales within health boards and local authorities, let alone between them, so that will just continue.
So they will remain their employees. Who will the body then employ?
It will not have to employ anybody. It will not be an employing body at that point. The people delivering the services will still be employed by the council or the NHS board. They will not have changed their employers and there will be no requirement to do so.
Who, then, will give directions for what happens? How will a body share resources, put a budget together and then get people to work across sectors if they are still in their silos? How does this work? I am getting more and more confused by the answers.
This concerns the legalities.
For somebody in the local authority who provides social work services, the line management is through the local authority and ultimately to the chief executive. The chief executive directs that they follow direction from the chief officer in the chief officer’s role as operational director. They are then required to follow that direction from the chief officer as operational director.
If they are still paid by the local authority, why does the body corporate need a budget? If all the costs are undertaken, why do we need audit? If the body corporate only directs how services happen on the ground, why does it need a budget at all?
It is a question of control over the resource.
It needs to direct how that resource will be deployed by the people in the local authority and the NHS. The chief officer has the overall budget, and on the back of the strategic commissioning plan there will be changes required over a period of time. The chief officer, on behalf of the joint board, will direct those services to be delivered in a way that complies with the strategic plan.
I suppose that this gets to the difference between the body corporate model and—
—and the lead agency.
The lead agency model in your area, Rhoda, does not require that transfer of employment.
Some folk were at West Lothian yesterday, where it is already done and works very effectively. It is done very effectively on the lead agency model in the Highlands. Even in areas that have not had formal partnership agreements in the past, such as parts of Fife, it is done. For example, there is co-location in Queen Margaret hospital in Dunfermline between social workers and health professionals who all work as one team. It is done in Grampian.
You should curb your enthusiasm or any minute now you will be scrapping this legislation.
I want to get to the bottom of this. If, for example, you shift the balance of care from acute to care in the community and the body corporate decides that it does not need a consultant in an acute hospital but that it needs five or 10 more care workers for the cost of a consultant, does it tell the NHS to terminate that contract or not fill the contract as it would normally have done? Does it then go to the council and tell it to employ maybe five more workers? Is that how it would work?
There will be guidance about the directions that need to go to the health board and the local authority from the body corporate. That will be developed in good time. We would not envisage that they would be at that level of granularity. We would expect to see an expression in the strategic plan of a shift in investment and activity from one bit of the system to another.
The body corporate will not have the powers to direct. It may make up a strategic plan, but it has no way to fulfil that plan.
It has powers to direct delivery on the back of the strategic plan.
The accounting officer answers to the chief executive. Surely the chief executive can say, “No, we’re not going to do this.”
The chief officer will be accountable to the joint board for the functions that are delegated to that board to strategically plan the delivery of services. The chief officer will have a day-to-day role. That is built on models that are more or less in place—it is similar but not exactly the same. On the operational side—in the day-to-day role in the delivery of services—the chief officer will have a close relationship with the two chief executives.
I talked about directing, which is separate from exercising the power of direction. A power of direction ultimately allows a direction to be given to tell someone that they must do something. In the way in which organisations operate normally, a formal direction does not require to be given on everything that is done. Normally, people are asked to do things and they do those things. It is only when conflict happens and a requirement arises for a formal direction to be given that one is given.
You seem to be trying to legislate for good will. If the good will existed, integration would be happening, as in the Lothian and Highland areas. The bill will push people down a street. Unless somebody is empowered to take the lead when consensus does not exist, you are trying to legislate for good will.
The body corporate and the chief officer are empowered. Everybody needs to work on the basis of good will and trying to take people with them, but the body corporate has the ultimate power to do what is necessary to deliver an integrated service. The powers of direction to deal with a recalcitrant health board or local authority are vested in the body corporate. That has been missing and is why we have failed on integration for many years.
Given the available time, perhaps some of my questions could get written responses rather than answers now. Someone has told us that the term “public services” would be more appropriate than “public bodies” in the bill’s title, given what we are trying to achieve. Do you have a comment on that?
I do not see the advantage in changing the bill’s title at this stage. What matters is the bill’s substance, rather than its title. However, I agree that it is always desirable to have a sexier title if that is at all possible.
It was the independent sector that made the comment.
A lot of enthusiasm is out there, because people realise that we are serious this time. We are going to do this—there will be a law—and people will have no other option, so integration will have to be done.
The CHPs were not local enough—they lost the locality. That is terribly important.
That is right.
A lot of concern has been expressed that no complaints system is spelled out. Will you give detail—not necessarily now—on that? In particular, the disabled groups that we met yesterday said that, as have a number of other people. That is a concern given the different complaint routes—it is a bit like what Rhoda Grant has said about other issues.
We have a stream of work on exactly the issue of establishing a complaints procedure that is fit for purpose. Obviously, local authorities and health boards have different complaints procedures. We are working on that, but we certainly do not anticipate needing a big change in primary legislation to do it. I mentioned that we have eight working parties. We have a stream of work specifically on complaints, which will, I hope, report by, roughly, the turn of the year.
Yes, it will have reported by the end of this year.
My other questions probably should be given a written response. One is about the options that are being considered in relation to pension funding, including the costs.
Again, that is a wee bit of a red herring, in that the bodies corporate will not employ people and therefore will not be directly involved in pension issues. Obviously, however, over time, they might employ people, so there is an issue. If in future years somebody transfers their employment to a body corporate and their pension fund is in deficit, we have to ensure that we do not inherit a share of the deficit, which is historical. A technical amendment to the bill is probably required to deal with that. However, beyond that, we do not see a big issue with pensions, for the simple reason that the bodies corporate will not actually employ anybody.
The point was in connection with what is set out in the financial memorandum—at paragraph 116, to be exact.
I think that the Finance Committee drew that issue to the committee’s attention, but it is well in hand.
Okay. Another issue from the same source is whether any additional funding is to be provided in the event of a successful equal pay claim.
No, because it is nothing to do with us. If there is an equal pay claim in the local authority, whoever works for the local authority will be part of that settlement. If there are equal pay claims outstanding in health boards, the same thing will happen. We are not employing anybody. It is the employer who has to settle with the employee on equal pay.
Almost finally, do we have costs for the provision of funding for delivering Healthcare Improvement Scotland inspections under the integrated model?
At the moment, the Care Inspectorate and Healthcare Improvement Scotland can with my permission carry out joint inspections. We will lodge an amendment to allow them to carry out those joint inspections without always having to come to me for permission—in fact, I think that that is already in the bill. As you probably heard earlier, the Care Inspectorate and HIS are working together on the implications of integration for the delivery of inspection services. HIS will launch a consultation fairly soon in which one of the subject areas that will be covered will be the implications of integration. Obviously, eventually, we will need a more integrated inspection regime.
Finally, we know that most partnerships, apart from Highland, appear to be going down the body corporate route, but do you have final figures on that yet?
A couple of areas have explored the lead agency model but, to the best of our knowledge—we are in pretty close touch with all 32 areas—the only part of Scotland that is likely to use the lead agency model is the Highlands. That is our clear impression at the moment.
I will try to keep this brief, not least because I have a meeting to get to at 1 o’clock.
Inevitably, there has to be a clear single complaints procedure to allow people to make complaints against the body corporate or the lead agency. There is no doubt at all in my mind that people need to have clarity on the complaints process. That is the stream of work that is being done that I mentioned earlier. The SPSO is involved in the group that is undertaking that work. It will report by the turn of the year. At the appropriate time, we will share the outcome of that with the committee before we proceed. We will consult on the working party’s recommendations, but my view is that the ombudsman is right about the need for a single complaints procedure for the services that will be covered. However, we will wait and see what the working party says.
The ombudsman expressed concern that work on complaints and scrutiny can sometimes drag on. He pointed to the Crerar review, which was commissioned in 2007. Some of its recommendations have still not been fully implemented. Do you intend to pursue the issue with some vigour, to ensure that there is not an unacceptable lag between implementation of the legislation and implementation of a standardised complaints procedure?
I say unequivocally that there will be no dragging on my watch.
Thank you very much.
I understand that you were not here for the whole of our earlier session, cabinet secretary. As I said to the ombudsman, we made similar recommendations about complaints, commissioning, the development of the new workforce and national care standards in January 2012. Many of those recommendations were accepted by the Government. That was 18 months ago, so there are significant questions to be answered.
As far as the way forward that we have agreed is concerned, we do not see any need for additional primary legislation beyond what is in the bill. On the complaints procedure, there is already a substantive legal framework for complaints in Scotland. We are talking about the process, rather than the statutory basis of the complaints procedure.
To support the ombudsman’s claim, there is much that could have been done on the national care standards and outcomes—on which the committee made unanimous recommendations that were accepted by the Government—over the past 18 months. What has held us back?
I do not think that we have been held back. Certain things happen at certain times. The priority has been to get the principles of the bill agreed. On complaints, we have not been sitting back doing nothing. Work has been going on on complaints over the past 18 months. Obviously, we have to try to take people with us. In this case, that means COSLA, and it is heavily involved in the complaints work that will report at the turn of the year.
I am sorry to press you, cabinet secretary. You said earlier that we do not need the bill to deal with complaints or the national care standards. If the national care standards have not been reviewed in nearly 12 years, why has that work not been completed in the past 18 months?
First, in terms of complaints, what I am saying to you is—
We were talking about the national care standards, not necessarily complaints.
Sorry—I thought that you were talking about both. On the national care standards, we looked carefully at the committee’s recommendations and accepted in principle the need for review. One issue is that we need to consult the appropriate people before we announce a national review of the national care standards. Also, we wanted to be a bit further down the road with the bill and all the infrastructure around it so that, by the time that we reviewed the national care standards, people could look at that in the context of knowing the shape of the bill, which will impact on what people say about the future of the national care standards. In particular, there is an issue around the future interplay between clinical standards and the national care standards. This is the appropriate time to review the national care standards, now that people know exactly what is happening on integration.
In the parliamentary debate at the beginning of the process, the cabinet secretary gave a commitment to Parliament that we would ensure that the review of the care standards was carried out with our informal process for looking at outcomes. The national outcomes that we have put into the consultation must link together with the care standards. As we speak, we are going around the country asking members of the public, including older people’s groups and broader groups, “This is what we’re planning around care standards. What do you think about the future? Here is what we’re saying about the national outcomes.” We have brought the two processes together. My team and colleagues from the care standards and sponsorship branch of the Scottish Government are jointly going around the country, talking to people on the ground about the care standards and the national outcomes. We wanted to avoid totally confusing everybody about what the care standards and the national outcomes are, so we are having joint presentations, joint discussions and joint debates both with members of the public and with the professionals.
I am pleased to hear that, but I must have missed it in my constituency. I do not know whether any other committee members have come across it. It would be interesting to hear about it.
We could give you a list of places where we have been. We started in Shetland and have been down to Dumfries and Galloway. We have also been to Paisley, Dundee and Aberdeen. We can give the committee information on that.
It would be nice to hear about that work. I make a plea on behalf of the committee. We have done a lot of work in the area and have made a number of recommendations. There was an indication that the committee would be kept up to date with that work, and it would be useful if we were. I am glad to hear that we are making progress in and around the complaints work.
Yes. That is no problem at all. If there is anything that the committee feels that it needs additional information on, we will supply that—no problem.
I thank you and your colleagues for your attendance this morning.
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