Health Committee, 02 Nov 2004

Meeting date: Tuesday, November 2, 2004

Official Report 261KB pdf

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Budget Process 2005-06

I welcome the witnesses for agenda item 2, particularly the Minister for Health and Community Care. Am I right in saying that this is the minister's first appearance before the Health Committee in his new role?

Bar the motion on amnesic shellfish poisoning—that was a minor show.

That is right. I had forgotten that you were here for subordinate legislation. I invite you to make a brief statement to the committee.

This is my first substantive appearance before the committee and I am pleased to be here.

Members have before them the spending review 2004 figures. The committee is primarily discussing the 2005-06 budget, but we have also announced headline figures for 2006-07 and 2007-08, which show respective increases in resources of 8 per cent and just under 8 per cent. The corresponding figures for capital, which it is important to mention, are 8 per cent and 16 per cent.

Some of the figures are not fully broken down and there are a number of reasons for that. First, we are updating the needs assessment formula—the Arbuthnott formula—and that will affect allocations to boards. Secondly, we have the resources that we need and I am working on an announcement for December on further plans to improve services to patients, which will use some of the extra resources. Thirdly, the amounts that are required for primary care are dependent on negotiations with various professions that have yet to take place.

The committee has taken a keen interest in two particular issues: pay modernisation and measuring increased outputs from increased resources. Most of our budgets and most increases go on NHS staff pay. That is an important point. I am fed up with the phrase "the black hole" being used in relation to pay, because what it implies is not the case. Resources are spent on our staff, who are key players in health provision, to ensure that patients receive a high standard of service. That high standard is reflected in the satisfaction surveys that we conduct in the health system. At my first substantive appearance before the committee, it is fair that I say that I have met some highly skilled and motivated people. I recognise that those people are not only highly trained but highly committed to the public who rely so much on the service. Clearly, we want to reward those staff properly. We need systems that facilitate service improvement, which is where much of our resources go. Spending money on staff and on pay modernisation to recognise the contribution that staff make is not putting money down a black hole.

I share the committee's frustration on outputs, which are an issue that I need to resolve. We need to be able to analyse the many good things that are happening in the health service and to report on them more adequately. During my early visits to places such as the Leith community treatment centre and other general practices, and in my visits to general hospitals and university hospitals, I have seen the big changes that are taking place. I am sure that committee members are already familiar with those changes.

So that we know more, and so that we can hold our health board colleagues to account more appropriately, I have written to all health boards to ask them to highlight what they believe have been the key service improvements. The responses are coming in as we speak. In addition to receiving those big headline messages, we also want to ensure that we address the data deficit. As I have said previously, that is very important to me. Many new things are happening in the health service that are good for the patient, but we need to capture those things and account for them appropriately.

Finally, on resources, the amount of money that is provided is always important, but it is recognised that spending on the service is at unprecedented levels. We need to ensure that the money is spent properly, and I hope to make an announcement on that to Parliament in December. That is roughly how I see the budgetary position at the moment. In December, I hope to announce further information on how the resources will be spent in favour of the Scottish patient and the Scottish public.

The committee's adviser, Andrew Walker, has produced some interesting figures, which are based on the cost pressures that have been identified by Audit Scotland and other sources. In 2003-04, such cost pressures accounted for 71 per cent of the new money that was allocated to health boards. As the minister will know, three health boards ended that financial year in deficit. The adviser suggests that that percentage figure will rise to 82 per cent for 2004-05 and to 141 per cent for 2005-06; although we do not have figures for 2006-07 or 2007-08, I assume that that figure will continue to increase. In other words, although new money is being provided, the immense cost pressures are greater than the new moneys that are being made available. That suggests that more health boards are likely to end the coming financial year and the following financial year in deficit. Is that a concern?

It would be a concern if I shared the adviser's view. With due respect to Mr Walker—whom I have met only fleetingly in the parliamentary campus—I question some of those figures, which I have had a quick look at only in the past five minutes or so. Are the figures cumulative or year on year? I question some of the resource allocations, especially in the first section of the statistics, which were made available to us just prior to today's meeting. I am more than happy to meet Mr Walker to ensure that we come to a common understanding about whether the moneys in the table that he has produced are cumulative or year on year. That makes a substantial difference to the calculations.

Secondly, by dealing only with new moneys, the adviser's paper does not make a fair assessment of the position of the health service. We are dealing with a substantial budget that is undergoing changes in the way that it is used. I think that the adviser's analysis does not take due cognisance of the on-going reconfiguration and redesign of services in our national health service. Those changes are providing some extremely focused benefits for the general public who use the service.

In terms of future provisioning and analysis of the money that is left over for new initiatives, what cognisance has been taken of service redesign and reconfiguration, which also have an impact on our resources? Further, where do the base figures come from? Were they the base figures for 2002-03? Again, depending on what base was used in the first instance, the bottom line of the grid that I have just received could be questioned, as could the position that is put by the member.

I would be happy to engage with the committee on this matter. I have serious doubts about some of the content of the adviser's paper, but I believe that we should reflect on the fact that the health service is changing. We should be dealing with the whole budget because it is being used to deliver service reconfiguration and redesign in ways that will provide better productivity, which will allow resources to be spent elsewhere in the service.

We suspected that you would not be in a position to respond to the figures in detail, given that you have only just seen them. A meeting would be helpful, but it would also be helpful if you could provide your alternative analysis and figures to ensure that we are comparing apples with apples and pears with pears. There is cause for concern with regard to the general trend of the figures. You might dispute some of the detail of the figures, but if the cost pressures are a trend, there is certainly cause for concern. Obviously, we look forward to being reassured by the minister on that point.

I am happy to do that. Obviously, I would rather not do it in such an adversarial manner. Instead of providing alternatives to the views of the special adviser to the committee, I would rather that the officials worked together to come to a common understanding of some of the questions. I am happy for that engagement to take place. I am not sure whether the member is referring to the fact that, on one occasion she says that the NHS is awash with cash, while on another occasion she says that it is starved of cash.

We are not being adversarial.

I think that you are, to a degree. I am happy to establish various points through discussions with the special adviser.

The special adviser is happy to meet your officials and discuss the various points. The committee will decide whether that should be an accompanied discussion.

I will start with a simple question about comments that were made by both you, in your former role as Minister for Finance and Public Services, and the First Minister. You talked about 2 per cent savings in health—where in the health service system will those savings appear?

We should beware of simple questions, as there are no such things.

The efficient government contributions to the health service come largely from procurement. Peter Collings might be able to give us some more accurate figures about the contribution that has come from that direction. Further contributions have come from the service redesign initiatives that have been undertaken through the centre for change and innovation.

We have a target of saving £50 million on NHS procurement by the financial year 2006-07 and we would hope to have done better than that by the end of the period relating to the efficient government announcement. We have also kicked off a project for shared services, which will mean that payroll and financial systems will be provided once for NHS Scotland rather than around 20 times as happens at the moment. There are further projects to do with benchmarking and the estates, which should lead to savings.

Those are the kind of areas that we are considering. More detail will be available when the efficient government plan is published.

I presume that the 2 per cent figure applies only to the areas that you have detailed, as opposed to it being 2 per cent of the global sum, which was the impression that the First Minister gave.

The amounts that I am referring to add up to 2 per cent of the total sum. We have some specific savings that add up to 2 per cent of the total health budget.

I have some specific questions on what appears to be your budget—I say "appears to be" because there might be qualifications.

Over the past few years, the ministry has emphasised the delivery of more care in the community. However, over three years, there appears to have been a reduction in the money that is spent on community care. As the previous witnesses said, there has been a reduction in funding for the postgraduate education of all types of medical professionals, not just doctors. There does not appear to be any increase in the funding for the ambulance service, yet the previous Minister for Health and Community Care talked about the ambulance service helping out with regard to out-of-hours care. Further, no inflation figures seem to have been built into the drugs budgets. Can you be a bit more precise about those questions?

I will try to. If I miss one of them out, I will try to return to it.

The drugs budget is an estimation of what we see in terms of our ability to purchase better. I hope that, if we purchase properly and effectively, through some of the work that we are undertaking, we can obtain a reduction in that line of the budget and spend that money elsewhere in the service.

The vast majority of community care funding goes through the grant-aided expenditure line in the local government settlement. There is also work going on within the centre for change and innovation and with the Convention of Scottish Local Authorities and others to ensure that we do that work more effectively and efficiently. There are a number of aspects to that that I think are important. Also important are the targets that we have set for the health service around care of the elderly within their home settings and the targets that we have laid out to provide more care and support to keep people at home as opposed to their entering the health system through the acute or general hospital structures.

If we get this right, I am convinced that all those measures, taken as a package—and working with the acute doctors in our health service, who are beginning to work more effectively across GP practice boundaries to provide care in local settings—will allow us to achieve our targets within the resources that we have allocated to them.

On training, I defer to Mike Palmer, as he deals with our work force planning.

On postgraduate medical education, the amount of investment in junior doctor numbers and the doctors that we have in training has been increasing year on year since devolution, so that we have had an increase in doctor numbers of 14 per cent over the period. The increase has been across senior house officer, specialist registrar and pre-registration house officer grades. That is all extra investment that is going into postgraduate medical education.

For the first time, the new consultant contract gives consultants a protected amount of time in each working week, under their job plan, for supporting professional activities such as those that they are asked by employers to undertake to supervise postgraduate medical education. A range of measures is being progressed to ensure that we protect the balance that is required between service delivery from consultants and their responsibilities for postgraduate medical education. Indeed, we undertook a constructive and positive piece of work with the royal colleges earlier this year in order to issue joint guidance that was agreed between the British Medical Association, the Scottish Executive Health Department, the royal colleges and the employers. The objective was to ensure that, in the delivery of a new consultant contract, consultants' postgraduate medical education needs were balanced properly and appropriately against service delivery needs. A range of measures and initiatives has been taken to ensure that that investment is protected and sustained.

It has been mentioned that three health boards are having difficulty in matching their budgets, and that situation is likely to get worse. A statement has been made regarding support for Argyll and Clyde. Do you have enough money in reserve to transfer that statement of support across the whole of the potential problem? If so, what is the basis of that reserve and where does it come from?

I expect any public organisation to live within its budget. What I have said to the individual patients who rely on the service, especially in Argyll and Clyde, is that they can rest assured that the service will continue and that health care will continue to be provided for them. I will need to look carefully at the position of that health board. I have indicated that I will not underwrite the board's capital difficulty, but that I will deal with the revenue implications to ensure that the services continue. I am due to meet the health board very soon—either tomorrow or the next day—to have a real look at the recovery plans that it is putting in place and to ensure their viability.

I will go no further with regard to that particular health authority. On the generic question about authorities that project a deficit, I fully expect the boards to deal with the projected deficits by taking measures within their areas.

Do you have a reserve?

The Executive always has a reserve. It would be unwise for a finance minister not to have a reserve. However, I do not see the reduction of health board deficits as a valuable use of it—the boards should be able to sort out those matters from within their boundaries.

I welcome what you are saying about patient care, minister. Are you also saying that you do not rule out the abolition of Argyll and Clyde NHS Board?

I do not rule it out. As has been noted in the press and elsewhere, I want to consider the recovery plan and structural issues in Argyll and Clyde NHS Board, such as how it has been set up and how it is managed. I rule nothing out and I rule nothing in. I want people to read right to the end of this sentence in the Official Report of the meeting: abolition is a possibility, as is my acceptance of the recovery plan, after which the board could get on with its business.

Your primary concern will be the patients who receive the services.

My primary concern will be to ensure that health care services are provided for individuals in that locality.

What does the situation suggest about the ministerial intervention two years ago? What lessons will be learned from the obvious failure of that intervention?

That is the purpose of my meetings. The reading that I have done suggests that some of the issues that are being faced go back to before 2000. I need to understand what actions were taken as a result of the intervention; I need to know whether the work that is being carried out addresses the core issues and will therefore place the health board back on an even keel, or whether there is a structural problem that cannot be managed out through the recovery plan. I do not undermine those who are trying to resolve the problem—I hold them in high regard. However, I need to work out whether we have set them a fair task in asking them to resolve the difficulty with the running of Argyll and Clyde NHS Board and whether we can expect a recovery plan to be successful. I will not make judgments until I have had a proper discussion with those people.

The issues go back several years. We have taken a number of measures that, to date, have proven to be unsuccessful. I need clarity about the recovery plan and whether it will be successful and, if it is proven that it will not be successful, what decision the Executive will take. That clearly requires a full discussion and further reflection.

I presume that, in the past two years, it must have been reported to the Health Department that matters were not going well. We have not just landed here out of the blue. Some responsibility for the situation must rest with your department.

If the issue is about the allocation of blame, I am happy to accept—

It is about learning lessons.

We replaced a number of senior managers on the board. To learn the lessons, we must assess whether the task of recovery that we set for them was fair or whether the structure and organisation of services in Argyll and Clyde NHS Board makes it difficult to provide those services.

Ministers have taken action, but there needs to be flow-through. Just because a new management team has been put in place to tackle the recurring deficit and structural problem, that does not mean that, even after 18 months, the issue will be sorted out. There is not an overnight solution. I must reassure myself that the board has a strategy that addresses the key issues and will make the health board sustainable in the longer term.

Bluntly, another management team or set of recovery plans ain't any use—we need a long-term fix. That is what the critical discussions that I will have will be about. I will not say at this stage how I will approach the matter, because a range of options are available to me, from saying, "Thank you very much, that is a fine recovery plan and I am confident that it will work," to saying, "I'm sorry, I do not think that that will work in the long term, so we must address structural issues and a number of steps may have to be taken." There is a range of prospects, but I have not yet had the opportunity to meet the people in the front line to discuss those prospects.

In your response to Duncan McNeil, you suggested that disbanding Argyll and Clyde NHS Board was not ruled out. That would be a serious step, but it could not happen in isolation. If you were to take that step, you would have to consider a general reorganisation of health boards. The impact of such a disbandment on the west of Scotland would be immense. Are you seriously suggesting that the problems of one health board may lead to a complete restructuring of health boards?

I do not think that a general restructuring of all Scotland's health boards would be a valuable exercise right now. I have sent a strong message to individual health board chiefs and chairs saying that they must plan their services more regionally, taking account of their relationships with neighbouring boards and with national centres for particular services. I am not impressed by the lack of regional planning and the lack of understanding that a decision in one health board can impact on other health boards. Because of a lack of discussion, plans have not fitted together for Scotland. There has been a problem, but the solution is not necessarily a full-scale restructuring of health boards. However, I do not rule that out if the boards do not get their act together and work together across boundaries to provide better services for patients. We are dealing in perceptions and there will be a meeting tomorrow.

To get back to Shona Robison's original question about Argyll and Clyde, I would say that, if any minister went down the route of disbanding the board, a full assessment of the implications would be carried out. At least three neighbouring health boards would be affected, but we would not take such a step without thinking through the consequences.

I want to move the focus of the questions on to targets for maximum waiting times for patients. A lot of resources are going in that direction and the Executive has achieved its first target, which relates to treatment for in-patients within nine months of diagnosis. However, the Executive has also set targets for maximum waiting times for patients for consultation and treatment. The Executive aims to reduce waiting times further and an announcement is expected in spring next year.

The first target of nine months has been achieved and, as of next year, we will have two major targets of six months. Would it not be more sensible to wait until we see whether the Executive, by focusing its resources, manages to achieve one target—and it is important that patients do not wait more than six months—before announcing further targets? We should evaluate the success first.

That is a view, Mike. I will not say that it would be the wrong approach, but I will say that the evidence that I have is that we will be able to meet the targets. The pressure from patients is that we should deal with waiting times much more effectively. I would not set targets without full discussion with all the professionals and service providers, to ensure that we set targets that are stretching and demanding but not unreasonable.

I am wary of setting too many targets. Health board chiefs and chairs have said to me, "Just tell us what you want to do; don't give us all these targets." Across the Executive, not just in the health service, we have sought to reduce the number of targets. We have not simply dropped them and forgotten about them; we have ensured that they are subsumed under the portfolios of ministers. We will ensure that the targets are still met, but the issue will no longer be so much about having publicly owned, accountable targets. We are reducing the focus to ensure that the correct work is being done.

We are making great progress on waiting times. It is a serious issue and we are putting serious money into it. However, there is enough patient demand and there are—if I may be blunt—enough resources through the spending review to allow us to be more challenging, particularly with service-specific targets, and to ensure that we deal with communities' concerns about the health service. Targeting in the health service is critical, because, after all, one person's target is another person's diversion from another activity. As a result, we must ensure that we provide the full additional resources that are needed for service-specific targets so that our approach does not have any consequences for delivery elsewhere in the service.

I do not rule out any further use of targets, because they are a useful and indeed valid way of holding our health boards to account over the public's perception of the service and ensuring that the public are well represented in the health relationship. We have received enough data about our progress on our top-line targets and do not think it unacceptable to introduce other targets as and when we are ready to do so.

But I am talking about major targets. We must not forget that the vast majority of people are seen relatively quickly. However, as a constituency MSP—and I am sure that the minister has had the same experience—I find that people seem to contact me more about waiting times than about almost any other issue. I am not criticising targets—indeed, it is important that we have specific, measurable, achievable, realistic and time-related targets—but surely we should focus on the fact that we have met the target that has already been set.

Perhaps we misunderstood each other. Setting condition-specific targets for an individual procedure or episode will have an impact on the overall target, which in this case is waiting times. The two aspects work with each other to help us to achieve our overall target. My job is to ensure that the targets are sensible and link up. In my discussions with the royal colleges, the health board chairs and chiefs and consumers, I will make it clear that those targets can be made sense of and met.

There has been a lot of discussion about targets, which are an important issue. When I was a member of the Finance Committee, we requested a reduction in the number of targets and asked for more outcome-based targets, because we were finding it difficult to see how things were being achieved. It appears that the number of targets has been reduced from 14 to nine but, on page 53 of the budget document, five old targets have been subsumed under target 1, which brings us back up to 14 again.

Earlier, you said that old targets have been dropped only where they have been achieved. However, it is not clear whether targets for hospital-acquired infections, additional nurses and midwives and so on were met before they were dropped. As far as target 1 is concerned, instead of having specific targets for smoking and alcohol consumption, we now have a general aim. It worries me that the two issues that have the most impact on health and the health budget are no longer covered by specific targets. I do not think that the previous targets for reducing smoking were all that ambitious, but we have thrown the baby out with the bathwater. On the earlier question about whether additional burdens are contributing to deficits in health boards, that can be discussed between officials and we could receive hard figures, but the question of targets has to be handled differently. I am just worried that we have missed the mark on this occasion.

I am happy to correspond, through the convener, with Kate Maclean on that point. I have an explanation of every target that we have had and of where that target has gone. On occasion, targets have been subsumed under other targets, but some targets no longer exist because they have been achieved. There are also targets that find themselves placed elsewhere because of the way in which we do things. For example, there are individual targets within the tobacco control action plan and the dietary action plan. We have reduced the number of targets by absorbing them within other targets, by deleting them because they have been achieved or by picking them up elsewhere in the system.

Health improvement strikes me as the most important issue that we have to deal with. Although we spend a lot of time on targets and on the acute sector, the overall direction that I shall be taking will be a rigorous one that will refocus resources and effort into health improvement. I shall therefore want to come back to the committee on targets concerning the areas—diet, smoking cessation and physical activity—that are dealt with in "Partnership for Care: Scotland's Health White Paper" and in other documents. We have also set ourselves targets that are relevant to treatments, to ensure that people do not die of specific diseases and that they are treated quickly and effectively. Those are also valid targets, so there are two sides to the question.

I shall reflect on the point that was made about whether the targets are better. As Minister for Finance and Public Services, I was keen to ensure in my discussions with individual portfolio ministers that we did not have any targets that were not SMART. I take some of the points that have been made, but it would probably be the subject of another paper or correspondence if I were to give you the all the details of the issue.

I shall stick to the theme of targets. Looking at the Scottish Executive website and reading some of the papers, I noticed that there seemed to be a subtle change. I am particularly concerned about dental health—I know that other colleagues share my concern. It seems that there has been a shift in dental health towards new targets, with the emphasis primarily on dental disease in children and a shift away from the previous targets shown on the Scottish Executive website. That causes me concern, especially in relation to the target for reducing health inequalities by increasing the improvement across a range of indicators. If you have good dental health, you will have a good diet, because you can eat carrots, apples and other good fruit. If you do not have good dental health, that causes problems.

As I said, a subtle change seems to have taken place in the targets. I support the idea of targets, because politics is always about the language of priorities and I think that targets can help us all to sing from the same hymn sheet when we are trying to address some of the nation's key issues. I represent one of the poorest communities in Fife and I know that you want to address health inequalities, minister, but I do not see how the new targets will do that.

The subtle difference between the two documents clearly did not escape you. On the generic issue of dentistry, the Executive recognises the problem and accepts that what we are doing just now is not sustainable. That is why there is a substantial consultation on the whole question of dentistry, to which I hope to respond before the end of the year. Details of our work to ensure that provision is made available to communities will come out of the response to that consultation.

On the subtle change that you have asked about, I can only look at the two targets, compare them and get back to you with more detail about what the change means in terms of service delivery. In all our plans, including the work force plan, we are setting our future projection of a work force to take account of some of the changes and the problems that we have with delivery. I shall look more closely into the point that you raise and get back to you on it.

I have a brief question on the back of that, which links targets in general health improvement to other silos and agencies in the Scottish Executive. Can you detail the budget agreements that you have reached with other ministers on cross-cutting in health improvement?

We have come to and will continue to come to substantive agreements with other ministers, particularly with the Minister for Education and Young People on healthy diets, the quality of school meal provision and the physical activity task force. There has been substantial cross-cutting in the budget with regard to justice, specifically on the treatment and prevention of drugs misuse. I recall that the figures were £6 million for dietary matters and about £5 million for the drugs initiative. Basically, those are health moneys that work outside silos and across portfolios in the Executive. Likewise, resources go in the other direction. A number of ministerial cross-cutting sub-groups exist to ensure not only that each minister is aware of their individual responsibilities within departments, but that resources that are required to deal with issues generally are aggregated into the middle. We are getting better at that.

I have a quick question on the back of Kate Maclean's comment. I, too, spent some time on the Finance Committee and I recall that we asked for clear flags to be put in the budget documents from individual ministers to show which moneys go into cross-cutting initiatives. Would you be good enough to send us a quick paper on that?

Sure. I just asked Peter Collings whether we had clear flags. I know what the issues are, which is why I can point to the £6 million for diet and the £5 million for drug action and prevention. I am happy to deal with that point as quickly as possible.

The £6 million for diet is welcome, but am I correct in saying that you do not have a target for a reduction in obesity levels?

I do not think that we do, but we work through agencies and partners and, as I begin to focus my efforts in relation to health improvement, I will return to that issue, because it should be our primary focus.

I have a couple of questions on blocked beds. Whether we agree or disagree with targets, we would all agree that, where they are set, they must be evaluable. The second part of the target on blocked beds states that the number of people who wait more than six weeks will be reduced to a minimum, which seems to be based more on opinion than on an evaluable target. How do you plan to measure that? Have you costed the blocked-bed target?

First, I have some experience of the issue from my time as minister responsible for local government. We are doing better at local co-ordination, but not well enough. Although COSLA and health boards are working more effectively on the joint agenda, performance is not as good as it should be. It is getting better, but it is not good enough.

Target 6 is for a 20 per cent reduction year on year between 2005 and 2008, which equates to taking around 400 blocked beds out of the system per annum. That suggests a minimum of about 800 beds. However, we want to get the figure down, because we do not want anyone to have to wait for more than six weeks. A 20 per cent reduction per annum is realistic and is backed up by the resources that are required to provide the right care settings.

There is also the issue of chronic disease management and the idea that we should stop people going into hospital in the first place. The work that is being carried out by the centre for change and innovation and the acute consultants will help us to achieve that target from both ends. In other words, it will, first, get people out of the system when they should not be in the system and enable them to get to appropriate care settings and, secondly, it will stop people going into the system in the first place. We hope that that two-pronged approach, which will be resourced by the Executive, will be successful.

You have spoken about partnership working, with COSLA being the main partner. Is the target that you are talking about only for the NHS? Does there have to be a separate target for local authorities, or is there just the one target?

There is one target, for which both the NHS and local authorities are accountable in their respective roles. More and more community planning is taking effect in local government and more is being done on the joint future agenda and other collaborative work, which I hope will continue and begin to address the problems and needs of the service user, as opposed to the interests of health boards and local authorities. I am not satisfied with what is going on now. There have been improvements, but we can do much better. To reiterate, both the NHS and local authorities are responsible for what is a joint target and we need to keep up the pressure to ensure that it is met.

You said that a costing has been made. As I am sure our adviser will confirm later, it is always difficult to track where the money is. I am not sure that a specific costing can really be made. Are you saying that it would be easy for us to find out from the budget documents exactly how much money has been allocated to deal with blocked beds?

I will let Peter Collings answer that point in detail. It is difficult: when a constituency MSP sits down with the local health board and local authority representatives, they find that the board and the authority tend to blame each other for the people who fall through the net. That is not acceptable. As Minister for Finance and Public Services, I put onerous conditions on the release of any resources so as to ensure that we tracked that money through. We will find out in a few seconds just how successful that was.

In financial terms, a large part of joint working falls on the local authority side rather than on the health board side. As part of its submission on the spending review, COSLA put in what it thought was required in order to achieve the planned reductions. That was taken into account in the local authority settlement and it will be taken into account in the grant-aided expenditure allocations when they are announced.

I have a question on targets and blocked beds. The Executive's target 9 for health and community care was to

"reduce the proportion of older people (aged 65+) who are admitted as an emergency inpatient two or more times in a single year by 20% compared with 2004-05, to release capacity in hospitals."

That is a specific figure. We all know that it is cheaper to treat people in the community, but the big problem is that a revolving-door pattern can sometimes emerge. If somebody comes out of hospital and is not that fit, they can go back in very quickly. There are costs involved in that. The target is admirable, but I was wondering about the workings and the cost behind it. How many people are affected? What would the trend be, even without a target? What would the cost be?

I do not know off the top of my head the number of people who are affected. Peter Collings might be able to help with that but, if not, we will correspond with Dr Turner. The issue relates to some of the discussions that are, and have been, taking place on the subject of service improvement.

On chronic disease management, there is an issue of how we provide the right service through general practices and community health care settings and how we ensure that the required support is given so as to avoid the chronic diseases developing in the first place. I see that as part of a continuing trend of more and more services being provided in local settings, ensuring that the needs of the individual patient are put first. We have banked some of the innovations in that service area in relation to our ability to reduce the proportion of older people admitted as set out in that target.

Chronic disease management is about the roles of the consultant and the hospital and their relationships with the GP in the local health care setting, as well as about the adaptations being made and about service providers going to the patient, as opposed to the patient going to them. Community health partnerships will play a significant role, too. The issue is about how we see the service developing. We are content to set a target that we can reduce if we get things right, as I am sure we will. We need to deal with individuals differently with respect to their health care provision.

You expect that it will take a long time for the numbers to reduce, which is why you have set the target for 2008.

I just cannot place the number in my mind—I have forgotten it. I am happy to correspond with Dr Turner on the detail of the numbers and the implications of the 20 per cent target. Off the top of my head, I remember that the figure for bedblockers is 20 per cent, but I cannot remember the other figures.

I have a wee issue to raise on the targets, which is that it would be useful to have comparative figures. For example, instead of target 9 saying that the aim is to

"reduce the proportion of older people (aged 65+) who are admitted as an emergency inpatient",

the target would start by saying, "Last year, X amount were admitted". If we had those figures for all nine targets, we could get the issues more clearly into perspective. Is that possible?

It is possible. The chief economic adviser audits all our targets in order to ensure that they are measurable and gives us his comments on them. The scrutiny process should ensure that the information can be provided. That is no problem.

My question relates to blocked beds and emergency admissions. Next year, the committee plans to undertake a long-term study on the impact of the various pieces of community care legislation. Target 7 says that you will

"increase the number of older people receiving intensive home care to 30% of all older people receiving long term care."

Although, again, you may not be able to give us the information off the top of your head, do you know what the current percentage is? As Kate Maclean said, it would be useful to have that information. Perhaps you could undertake to have the information sent to us. Do you have the figure for the costs involved in meeting the 30 per cent target?

I am happy to provide that information.

Can you give the committee an update on where you are in relation to the care home sector and COSLA? At last, they appear to be singing from the same hymn sheet—in the past, the Minister for Health and Community Care appeared to be holding back progress. The relationship between the care home sector and COSLA is the meat in the sandwich, so to speak, and it impacts on some of the targets.

In my role as Minister for Finance and Public Services, I did not share the view that the Executive was the problem. Significant resources were committed in order to resolve the problems in the sector. As the issue developed into a big crisis—three years ago, I think it was—we made it absolutely clear that, although the problem was not our problem, we would deal with it. However, we also said that COSLA and the care home sector had to deal with the issue using their normal negotiation procedures. We gave them the task of resolving matters and not always asking central Government to deal with the problem for them.

I am advised that, as we are still in negotiations, it is best that I go no further on that point. Members have to recollect and respect what the Executive did in the first place to resolve a particular problem at a particular time, making it clear to the two key parties that they would subsequently have to fix the problem themselves. Let us see how the negotiations continue.

I look forward to seeing the results of the negotiations and to hearing about your input. Given that the situation impacts directly on the Executive's targets, I find it strange that you appear to be so detached. Surely we are talking about key players.

With due respect, local authorities are elected bodies with their own responsibilities. If I were to direct the authorities from the centre on every issue, people would ask why we should bother to have local government in the first place. Local authorities have a job to do and they should do it in a mature fashion, as should the care home providers.

I said at the outset that, if we got ahead of ourselves in terms of time, I would give you the opportunity to make a few closing remarks, given that I asked for your opening statement to be brief. Do you wish to say anything at this point?

No, thank you. Obviously, I have a number of pieces of correspondence to deal with as a result of the questions. I am more than happy to accept some of the points that were made over objectives and targets. I look forward to dealing with the issue that Andrew Walker raised about the table.

Given that we hope to discuss the draft budget report a fortnight from today, we are under some pressure of time. You have made a number of commitments to give us further information and that puts some difficulties on our work programme. Are the commitments that you gave us manageable in the timescale?

I would hope so, especially as regards the points that have been made on the targets.

Thank you. I understand that we will hear from you again next week as part of our work force planning inquiry.

Thank you.

Before we have a five-minute suspension, I ask the committee to agree that, when we discuss the draft budget report a fortnight today, we do so in private. Is that agreed?

Members indicated agreement.

Meeting suspended.

On resuming—