“Accident and Emergency: Performance update”
Item 4 is the Scottish Government’s response to the Auditor General’s report “Accident and Emergency: Performance update”. Do members have any comments on the correspondence that we have received?
The correspondence from Paul Gray is quite interesting. We are beating ourselves up over not meeting our targets and yet what we are achieving is better than what is being achieved in the other nations of the UK and in some other countries overseas. I liked the bit that highlights the fact that the Canadian report, “Time to Close the Gap”
“singles out performance in Scotland as the benchmark to which Canada should aspire.”
That is quite commendable. It does not mean that we should not strive to meet our targets, of course. The targets are there for good reason, but it is encouraging to know that we are leading the pack, so to speak.
I take a slightly different tack. I found that I got halfway through Paul Gray’s response and I knew the state of affairs in Germany, the Netherlands, Australia, New Zealand, Canada and England, but I had to read further down before I came to Scotland. Quite honestly, I am not that interested in accident and emergency response times in Australia; I am more interested in the response times in Scotland.
There is no point in setting a target and saying that we cannot reach it but that we are still better than Australia. I do not think that it is acceptable for a director general to do that. For that reason, I refer colleagues to paragraph 22 of the Audit Scotland submission, “Accident and Emergency: Briefing paper to the Public Audit Committee”. It highlights that
“The number of people who waited longer than 12 hours in A&E ... has increased by 55 per cent”
and that
“it ... increased by 292 per cent over the last year.”
Paragraph 22 goes on to highlight that, in the same period, the number of patients who waited for more than eight hours went up from approximately 8,700 to 14,000.
I am sorry, convener, but I do not find Mr Gray’s response acceptable in the context of a Scottish national health service with Scottish targets, a Scottish Government and a Scottish Parliament with a Scottish Public Audit Committee. We are here to audit what happens in Scotland. A response that tells us about Germany, the Netherlands, New Zealand and Australia is irrelevant. It is not our job to consider those countries. I ask Mr Gray to focus on Scotland, please, because we are not responsible for the health service in New Zealand. I would like to hear more about what he is doing to address problems in Scotland than about what is happening on the other side of the world.
There are nine targets. Two targets have been met, as we have just heard from the Auditor General, and seven have not, and the performance against all of them is deteriorating. It is the trend, rather than the actual figure, that is interesting. That is a real worry.
However, there is a difference between the accident and emergency target and the other targets. We are told that the A and E target is evidence based—in other words, the consequences of not meeting a four-hour target mean poorer outcomes for the patient. The other targets are nice, but they are not clinical, and they do not have the same degree of clinical relevance. They are concerned with patients’ rights. For example, the 12-hour target—which we are not meeting despite it being a legal guarantee; heaven knows I have said that often enough—is quite different from the A and E target.
The trouble with setting targets is that it results in conscious or unconscious gaming. We saw that happening with the waiting times issue, to which the Auditor General has just referred. We now know that there are 13 units in our acute hospitals that are not governed by the accident and emergency waiting times targets. They are variously called clinical decision units, acute assessment units and immediate assessment units; I cannot remember the name of the unit at the Queen Elizabeth hospital, which is where all that came to light.
The question—I cannot answer it, and I am not saying that this is happening—is whether there is gaming going on, in which referrals are being made to those non-governed units in order to try to meet targets that are proving to be very difficult. Even though the targets are no longer set at 98 per cent—such targets were being met at one time—and there are now interim targets set at 95 per cent, those are not being met in specific areas, mainly in the west of Scotland and in Glasgow.
The report is unsatisfactory. We need to go back to Mr Gray and say that the Cabinet Secretary for Health, Wellbeing and Sport’s announcement on looking into those 13 units must be brought forward rapidly so that we understand the true position. We can then have a rational discussion, in either this committee or the Health and Sport Committee, or in Parliament, about the whole business of targets.
Mary Scanlon and I are leaving the Parliament, so we do not have an axe to grind in that respect. I have said, and my party is saying, that we really need to look at the target issue. It is not just about not meeting targets—the effect is causing the stress of not shifting things into preventive care and community care, and mental health and general practice are suffering as a result. Health services are deteriorating as a result of targets that no longer have the purpose of making the health service, and patient outcomes, better.
I should clarify that we actually asked Mr Gray to provide comparisons with various countries.
Yes, and they are very interesting, but—
I just want to clarify that Mr Gray included that information in his correspondence because we asked for information on benchmarking with various other parts of the world. We need to be careful in that regard. We are not here to defend Mr Gray, but we should be clear about the information that we asked for, and we asked for that information.
I support Richard Simpson’s point about the need for proper assessment of targets. I am told that Audit Scotland could assist us in that. It is probably a job for a future committee in a future session of Parliament, but all I hear at a local level in my part of the world are comments about the pressure that targets put on clinicians and staff. There needs to be a proper, rational, non-political discussion about the most appropriate targets.
It was not that long ago that Alex Neil, as the Cabinet Secretary for Health and Wellbeing, turned up at this committee to tell us why the Government was taking the target down to 95 per cent from its previous level. The discussion about the target is relative, as the target is now lower than the one that was originally set.
12:15
I have two points to make. One point—which the convener made—is that we asked Paul Gray for those comparative figures for the other nations in the UK and for countries overseas where he had those available.
My second point relates to targets. It is interesting to note that, in 2007, there were 200 reportable targets in the NHS and that figure has been taken down to 20. I agree that there should be a discussion on the appropriateness of those 20 targets. Are we getting information that will allow us to drive the national health service forward in the future? Will it give us the vision that we need to be able to allocate resources? In terms of resources, what is coming down the road is changing all the time and we need to be flexible in that regard. Will the targets that we are looking at give us the indicators that we need to enable us to be flexible and to adapt? That is a valid question that we need to discuss.
Okay, colleagues—we have here the response from the Scottish Government and there are a number of different options for how we take things forward. The first option is to note the correspondence, but having listened to members’ comments, I do not think that that is the direction of travel from the committee.
Perhaps we could highlight to the Government the various points that colleagues have made on the targets, including the point that Colin Beattie has just made. Is that helpful? Are we agreed on that?
Members indicated agreement.
On Richard Simpson’s point, can we get some information about the units that are not included in the waiting times targets?
On the centres that are not included? Yes, that would be helpful. It would also be helpful for the legacy committee’s work and the Auditor General’s future work to look at how that information could be provided at some point in the future.
Thank you, colleagues. As previously agreed, we move into private session.
12:17 Meeting continued in private until 12:54.Previous
Section 22 Reports