“NHS in Scotland 2015”
Item 3 is a response from the Scottish Government to the committee’s request for further specific information relating to the Auditor General’s report, “NHS in Scotland 2015”. I invite colleagues to make comments or propose actions.
The backlog maintenance issue is very interesting. The target is now a 2020 target. The previous target was a 2015 target, which was not met. I for one was certainly not aware that there was a new target of reducing the backlog maintenance figure to £100 per square metre of the estate by 2020, and only 10 per cent of the backlog is to be high risk. The new set of targets is completely different from the previous target, which was defined in millions of pounds. I am slightly concerned about the fact that we have new targets.
Even if we accept what the Government says in the letter, the present backlog balance is £181 per square metre, and 47 per cent of the backlog is high risk, which is a huge amount. I think that the information that has been provided obfuscates matters and that transparency is lacking. What it might be useful for us to find out is how much of the high-risk element is clinically important. I will give an example of something that is clinically important: in the past few weeks, there has been sewage running down the walls of the Southern general hospital. That problem has occurred on a number of occasions over the past few years. It seems to be such a high risk that it should have been dealt with. Our successor committee will have to ask Audit Scotland to look into the system in far greater depth and to produce information that is meaningful and helpful. I do not know whether it would be worth asking for intermediate targets, at least. If the new target of £100 per square metre is to be met by 2020, what is the Government going to do about the high-risk stuff?
My other concern is that what is low risk today might—if it is clinically important—become high risk tomorrow. The impression is given that we are talking about a fixed feast. That is not the case; things will come on to the agenda as risks, and things will move from being low risk to high risk. I feel that the whole process is extremely obscure. I am really concerned that the Government set targets for 2015-16, which it has missed by quite a long way, because the boards have not delivered on the existing high-risk elements of the backlog, as far as I can see.
Therefore, we should ask how much of the backlog that was defined to be high risk in each of the years between 2012 and 2015 has gone off the agenda. If what was high risk in 2012 has not been addressed by now, what is the point of defining it as high risk?
I do not disagree with what Richard Simpson says.
One thing that I am curious about is the fact that, in the past, we have been told by the Government that a proportion of the backlog would be dealt with by way of new builds and so on as opposed to buildings maintenance. At one point, the Government gave a percentage on that, and I am surprised that it has not given that figure this time. That would be interesting to know, because it could be that, if we understood what was to be replaced, the figure of £181 per square metre could come down substantially, which would answer some of Richard Simpson’s questions. That question should be asked, but it will probably be for the successor committee to do that.
I appreciate that it is for the successor committee to do that, but for those of us who have been on the committee for most of the session, it has been an on-going issue. It is not the first time that the Government, on being unable to change a target, has changed the date. In this case, it has changed it quite significantly, which is very disappointing.
I say to Richard Simpson that we asked for a definition of “high risk”. I do not want to use my words, but “high risk” means that something is fairly detrimental and, in fact, quite dangerous to staff and patients from a health and safety point of view. It is an issue that we have looked at over the five years of the session, and I agree with Richard Simpson that we should include it in our legacy paper for the successor committee. It is an extremely serious issue.
As far as Colin Beattie’s point is concerned, we have been given more explicit information in the past, which has helped our understanding. If an old hospital is not meeting the standards and a new one is being built, that information helps us to understand the maintenance backlog figures. We have been given less information, and a target that could not be met has been shifted far over the horizon.
11:15
I would like to extend the discussion by making the point that this is not a continuum—we are talking about discrete buildings, some of which are quite big and some of which will probably be underused. We all recognise that, if a building is old and the roof needs to be replaced, the whole building will be regarded as being at the worst end. It might not even be being used, or only the ground floor might be being used, or it may well be going to be replaced in a year and a half’s time, in which case no sensible person would expect anything to be done with it until the new one is built. Our successor committee or perhaps a future health committee will need to be able to extract the individual segments from the big numbers in order to understand what is going on. I suggest that average numbers do not help us.
I agree with my colleagues’ comments. It would be useful for our successor committee in the next session to get a breakdown of what is planned. As Mary Scanlon said, this committee has discussed the matter before. The information is relevant for a future health committee, but our successor committee should obtain that information, too.
I will make one final comment on this. There is much criticism of what were originally public-private partnerships, were then private finance initiatives and are now non-profit-distributing schemes—they are all the same—but they include a maintenance contract. Our successor committee should recognise that those are maintained buildings and that the contract requires the contractor to maintain them for the 30-year lifespan of the contract, which is a fantastic saving to the health service. If colleagues would agree to this, I suggest that, in our legacy paper, we invite a future audit or health committee to look at the savings that are accruing in that area. The backlog of maintenance and repairs has been up to £1 billion, with £250 million or £300 million of it high risk; now there is no backlog in the maintenance of NPD schemes.
Colleagues, I suggest that we pull those suggestions together. We could respond to the correspondence, asking for a response in the two-week period before Parliament dissolves; we could pass the Official Report of this meeting to our successor committee; or we could do both—see what information can be provided within the next two weeks and, if any further information needs to be sought, suggest that our successor committee does that.
I think that we should do both.
We should ask what was considered as high risk in 2012, 2013, 2014 and 2015 but was not about the replacement of buildings. Nigel Don is absolutely right to say that there is not a continuum. We should ask the Government to take out the buildings that are scheduled to be replaced and are not being used—in relation to which there is a general safety issue—and provide us with a list of the important high-risk items that relate to buildings that are being used for clinical purposes.
We need to be careful what we put in the legacy document.
Yes, but that is not for the legacy document; it is what we should ask the Government for.
I suggest that we correspond with Mr Gray on the points that committee members have made today and request a response within two weeks.
As a general point that we will come back to, we need to be careful that we are asking for things of significance. There will always need to be some kind of de minimis level, although I am not sure how we could set that. It could be addressed in the correspondence. We do not want information about 10m2 in the corner of the smallest and least relevant building; we need relevant stuff and should not ask people to do unnecessary work.
I think that we can ask for common sense to prevail but still put the question in the interest of openness.
Yes, please.
We cannot legislate for common sense.
Absolutely.
“Health and social care integration”
Item 4 is a response from the Scottish Government to four points arising from the committee’s consideration of the AGS report entitled “Health and social care integration”. Do colleagues have any comments to make?
The offer made is one that we probably would have taken up had we been carrying on, but clearly at this point there is no time for that. Is it a matter that should be carried forward for the next committee? We cannot put it in the legacy document.
We can ask for the matter to be on the record.
That would be useful.
Do colleagues agree to that approach?
Members indicated agreement.
“Implementing the Scotland Act 2012: An update”
Item 5 is a response from the Scottish Government on the AGS report “Implementing the Scotland Act 2012: An update”. The committee had asked the Scottish Government whether it accepted the report’s findings and recommendations. Is the committee content to note the Scottish Government’s response?
Members indicated agreement.
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