Arbuthnott Report
Item 5 is our old friend, the Arbuthnott report. It has been some time since we made our submission in the course of the Executive's consultation exercise.
For the sake of people who may have forgotten what the report is all about, it concerns the funding allocation for the national health service in Scotland. It was an attempt by the Executive to move forward from the old SHARE—Scottish health authorities revenue equalisation—system that had operated for the past 20 years.
We made a submission to the Executive, and we have received an interim response. I have discussed that response with John Forbes, who was our expert adviser on the Arbuthnott report inquiry, and I have had a chance to discuss it with representatives of the various parties.
I am generally pleased with the Executive's response, which is a move in the right direction. It is a positive response to the conclusions and recommendations that were outlined in our report. It accepts many of the major concerns that we raised, and they are now being addressed. The Executive's response mentions that our comments have been echoed by others during the consultation exercise, so we were obviously on the right track on several points. Sir John Arbuthnott has been asked to reconvene the steering group to examine the responses that have been received.
I welcome the positive interim response to our conclusions and recommendations. In view of the fact that the steering group is to be reconvened to address the issues that were raised during the consultation process, we should ask the Executive to tell us its intended implementation date for the Arbuthnott report's recommendations. John Forbes suggested that we do that.
The committee paper on the Executive's interim response suggests that we
"note that the Steering Group aims to provide the Minister for Health and Community Care with revised recommendations by 31 March 2000."
It suggests that we ask the minister whether the Executive intends to consult the committee again on the conclusions of that further work. It also suggests that we note the fact that further work is being done on inequalities, which was the subject matter of chapter 15 and one of the innovative parts of the Arbuthnott report. As further work is being carried out, we would appreciate it if the minister could indicate the time scale for publication of the consultation document outlining possible methods for addressing those issues. It is clear that the Executive and Sir John Arbuthnott are finding that that work on inequalities is taking longer than they had predicted initially.
John Forbes has suggested that the committee should be furnished with a membership list for the working group that is reviewing the general medical services model and the community data aspects of the report. Again, the committee highlighted those matters as being worryingly lacking in data.
Having gone through the Executive's interim response to the committee, I think that it is positive, and I welcome it.
I agree, but if further consultation takes account of inequalities and re-examines the GMS model, that will significantly alter the original report. Rather than ask whether the minister intends to consult us, we should say that we expect to be consulted. Taking those points on board will alter significantly the whole thrust of the document.
We should go through a further round of consultation. Our comments were based on evidence that we heard from organisations that will be affected by the report, directly and indirectly. Although I am not in the game of throwing it out again, we must reconsider the whole report. If we are to do as our adviser suggests, we should ensure that that is the best possible route to take. I understand that the further work on the GMS model will not be available at 31 March, but will involve longer-term investigation. I would like to know exactly what the Executive plans to introduce as a short-term measure.
I agree 100 per cent with what Margaret Jamieson just said. We must toughen up point 7 of our suggested response. If the committee is to play a serious role, we expect to be consulted again.
Point 6 states that
"the Committee would be obliged if the Executive could give an indication as to the intended implementation date".
It might be worth restating our resolution that implementation should be delayed until the changes had been analysed. That was the central contention of our report.
I have a number of comments on the Executive's response. First, on the stability of the formula, the Executive said
"Some Health Boards expressed concern that the proposed resource allocation formula might be unstable from year to year . . ."—
those boards included Shetland and others—
"The stability of the formula will be assessed by looking at how allocations would vary over a period of years."
I would like a more substantial response. We would have worked out that the assessment would be done over a period of years, so we do not learn a great deal from that response. We should ask the Executive whether it is taking the issue seriously, and what it is considering putting in place, rather than just letting it say that it will look at the matter.
We will ask for that.
Secondly, on the plausibility of the results:
"We are aware of a few areas where it is felt that there were some anomalies in the results for different Health Boards, and these are being examined."
Which health boards? Let us push the Executive to explain the basis on which results are being re-examined.
We highlighted Borders Health Board and Dumfries and Galloway Health Board.
Exactly, but the Executive should tell us when the re-examination will happen, to which health boards, and under which criteria.
A working group has been set up on general medical services, and a reference group has been set up on methodological issues. Would it be part of our role to ask those groups to liaise with us while we can still influence their thinking—before their findings go to the Executive—so that we are keying in to the process at a more useful stage?
Finally, the Executive made a point about remoteness adjustment and Argyll and Clyde Health Board, with which I am closely involved.
"Officials who have been closely involved in the Arbuthnott Review have discussed this issue with Argyll and Clyde Health Board and are considering how best to take into account the particular circumstances of Argyll and Clyde in an adjustment for remoteness."
Could we ask the Executive to keep us fully up to date with those discussions, and with the representations that are received from Argyll and Clyde Health Board?
I welcome the Executive's response; it addresses many of the major issues that we raised. Margaret Jamieson mentioned "throwing it out again", but I do not think that we threw out the Arbuthnott report last time. We recognised it as a work in progress. We have moved on, and the issues are being addressed.
On Margaret Jamieson and Duncan Hamilton's points, I am slightly worried by the language that is used in our suggested response to the Executive's response. For example, point 7 says
"The Committee would be obliged if the Minister would indicate whether or not it is intended".
That sounds as though we are begging. We will be consulted, and that is the end of the matter. The minister will get our opinion whether she likes it or not. Such woolly language—begging whether she will, perhaps, grace us with her presence—is nonsense. This is a partnership; we are not begging anyone.
Okay. Point 7 will be a clear statement that the committee will be involved in the consultation on the further work.
Or the minister will have to answer to Mary.
Once a teacher, always a teacher.
We will be consulted, and it will be up to us to decide whether we take further evidence. That picks up Margaret Jamieson's point that events have moved on considerably since the original report. If members cast their minds back, they will remember that one of the constraints under which were working when we considered the Arbuthnott report was that work was already going on in the background; we knew that we were on shifting sand. During the consultation stage, it would be right for us to consider whether we want to take further evidence, possibly from the Executive and the minister, and certainly from other people who were involved, such as Sir John Arbuthnott. That will be for us to decide.
I have a number of suggestions, which are not dissimilar to those that have been made by my colleagues. First, on point 6 of the paper on the Executive's interim response, after it says
"during the consultation process the Committee"
we should add that there is a need for further consultation after completion of that process. That would reinforce what we say in point 7.
I suggest that the last words of point 7 be changed to, "the committee wishes the minister to consult the committee on the conclusion of this further work before implementation." In addition, point 6 should come after point 8; the request to be consulted on the outcomes should come before the request for the Executive to state the implementation date of any recommendations.
Is the committee happy that we ask for the Executive's intended implementation date, and that, as Duncan Hamilton suggested, we restate the position on implementation that formed part of our initial report?
Members indicated agreement.
Last, we should add a clause to say that, in view of the delay, we would like a statement from the Executive on the interim measures to deal with inequalities that it may propose over the summer. We need some clarity on that, because our report called on the Executive to begin the process of tackling inequalities now and not to wait for Arbuthnott.
I too am bit concerned about the time factor. The three-month schedule that the Executive has set itself could be viewed as quite tight, but we do not know how much more time will drag on before anything is implemented.
I am also concerned about the paragraph on data quality on page 2 of Susan Deacon's letter, in which she largely defends the quality of the data used. It reads:
"The basic problem in both of these areas is the restricted range of data available, and the scope for including a wider range of data is being explored."
We should ask the Executive to reveal the range of data that is being considered or that has been pinpointed. I welcome the fact that the Executive will run data for two years after the one-year test, but may we ask that question?
That is perfectly acceptable.
I want to follow up on Dorothy-Grace's point. Point 9 of our response is a bit weak and shallow—all that we are asking for is the membership of the working group.
That might be the point at which we could add the need for consultation with the committee on both of the working groups that are being set up.
Yes. We can add that to point 9. We will also take on board Dorothy-Grace's point and ask for further information about the community data situation in general medical services.
We highlighted that point from the evidence that we gathered for our initial report. I am pleased to note that Professor Graham Watt appears to have been included in the working group. We should take some of the credit for that. However, we need to tighten up on that issue.
The committee can take quite a lot of credit for quite a lot of things.
I have a suggestion on what Richard Simpson said regarding point 7. Rather than saying that the committee wants to be consulted before implementation, would not it be better to say that we expect to be consulted before a decision is made on the time scale for implementation? Those are two very different things. That would make it a bit tighter.
That would be not a request, but a positive statement.
I think that that is clear.
We had worked that one out. I will have some of whatever Mary put on her cornflakes this morning.
Are there any further comments? No.
I thank colleagues, not only for their comments this morning, but for the incredible amount of work that they have put in on this issue in the past. I take on board the fact that the Executive's interim response to what I—and all members—consider to be a good committee report is generally positive.