“Accident and Emergency: Performance update”
I have a question following Willie Coffey’s very fair observation about what we can do to ensure that matters that we have considered come back to us so that we can properly assess them.
In his correspondence, Paul Gray deals very sensibly and constructively with the report’s recommendation on ensuring that
“NHS boards have access to benchmarking information on staffing levels”.
Yesterday, Health Improvement Scotland was called in to look at Aberdeen royal infirmary at Foresterhill. That is a massive issue for my part of the world, so I am very pleased about Health Improvement Scotland’s involvement.
Staff directly approached central Government, which took the sensible decision, in my view, to have an HIS inquiry rather than have the matter go through Grampian NHS Board. However, that is what worries me most, because the Auditor General and others who appear before us are always on at us about governance, and clearly something has gone wrong in this case.
I am not expecting this to be done today, because the report is retrospective, but in relation to future reports could the committee seek such assessments, with, for example, NHS Grampian being part of a properly assessed case study?
I thought that Paul Gray’s response was very effective: it was pretty thorough and addressed many of the committee’s concerns.
I was drawn to the benchmarking information and Paul Gray’s commitment to work with the NHS and the Scottish Government
“to ensure the relevant information is available so that Boards can make informed decisions on staffing levels and skill mix in A&E”.
Basically, that is what we heard about from Grampian at the weekend.
Could we consider taking further oral evidence on the issue, given the concerns that arose over the weekend? Paul Gray has committed to publishing more data in September. Given our timetable over the next few months, it might be October before we could take further oral evidence, so that would fit in with our working pattern. The information would be helpful, because it tends to highlight problems in Aberdeen.
I was not entirely sure about the reply on effective hospital discharge processes. Paul Gray says that the recommendation is agreed, but he also says that
“All hospitals have discharge processes”
and then he talks about a new model. I am not quite sure about that: if hospitals already have discharge processes, they have not been working. We should ask what has changed.
The question is whether we invite further evidence.
Like Mary Scanlon, I think that that would be welcome. I think that we should take it in October or November.
Do members agree to seek further evidence?
Members indicated agreement.
Do we agree to let the clerk suggest some witnesses?
I thought that we would just take further evidence from Paul Gray.
Tavish Scott has mentioned Grampian, so it would be useful to find out what is going on there, and we may wish to look at other areas. As well as hearing from Paul Gray, we need to find out from those on the front line.
To be helpful to James Dornan, let me explain that I am not asking for us to do any work before HIS reports; clearly, it would be right to wait for that. I understand from NHS Grampian’s statement yesterday that HIS is due to report this summer, for obvious reasons. October seems entirely sensible.
I agree that we should take further evidence. As Mary Scanlon suggested, it is right that we wait until after September, so that we can get an update on where we are.
There are two issues. One is the overall issue about accident and emergency, and it would be very useful to have Paul Gray speak to us about where we are at that stage. The second is the issue that Tavish Scott raised about Grampian. Should we treat those as two separate issues? That would allow us to bore down into the evidence. Obviously, there is a specific issue in Grampian.
There could be issues in other areas. In my area, the Royal Alexandra hospital in Paisley has consistently been one of the two worst hospitals in Scotland, and we have not been able to get to the bottom of that. It would be useful to find out from the health boards why problems with accident and emergency departments are significantly worse in some areas than in others, where A and E departments are doing pretty well.
Maybe that is the key. Tayside seems to be doing well, so perhaps we should hear from Tayside about what it is doing differently.
Totally. That is exactly right.
We move on to item 4. We have correspondence from the Scottish Government and Audit Scotland on the report. Do members have any comments?
That is a sensible idea. On a number of occasions, the point has been made that we should not just dwell on the problems but look at the good practice. Does the committee agree that it would be useful to hear from those who are doing well and those who seem to be struggling, and also to hear from Paul Gray?
I am not against the idea of taking evidence from others; I was just confused.
Is that agreed?
I am new to this. As a committee, do we agree whom we invite?
I will ask the clerk to the committee to circulate some suggestions, having listened to the discussion. The committee can then decide.
From my take on the matter, we have agreed that we should invite Paul Gray to give evidence; Bruce Crawford has also suggested that we look at Tayside. I will ask the clerk to consider whether we should talk to NHS Greater Glasgow and Clyde, because of the problems at the RAH. There are also issues in Grampian.
Can I make another suggestion about that pool? When we discussed the report, the point was made about the correlation between 999 calls and A and E poor performance. Can we make sure that the pool of people whom we talk to includes at least one of the organisations that has a high number of 999 referrals but does not do so well in A and E overall? I think that Edinburgh is probably one area where that happens.
That is a useful suggestion. Thank you.
We now move into private session.
11:25 Meeting continued in private until 12:03.Previous
Public Audit Committee Report