Health and Community Care Committee, 12 Jan 2000

Meeting date: Wednesday, January 12, 2000

Official Report 173KB pdf

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Future Business

This is a fairly broad agenda item and I wanted to raise a number of issues with committee colleagues at this point.

The first point relates to community care. I do not know whether all of you, like me, spent a large part of your Christmas and new year break reading the several hundred pages that we received in submissions to the community care review that we are about to undertake. Some of the contributions were excellent and the submissions made me realise that, no matter whether we spent the projected nine months on this issue or nine years, we would always be able to find another aspect that we should probably consider. Nevertheless, I think that we received a great deal of good information on the big issues. I also thought that it had been worth while to ask people for examples of best practice.

I found that reading some of the examples of what people were doing was illuminating. During the community care review that we are about to undertake, I want the committee to visit the places that make use of those examples and to find out more about them. We will consider that later on, with input from some of the experts who will work with us.

We wanted to have an informal briefing session on the bill in January. Unfortunately, Sir Stewart Sutherland—who is quite important in this context—could not make it on 26 January. The briefing will, therefore, be on 2 February. I have asked the committee clerks to make available the extra papers that were not sent out with the two files that members received.

There are more?

Indeed there are. Members will have read some of the documents previously—they are formal documents that are published by the Executive. Members should tell the clerk if they want copies of the files to be sent to them.

A range of people will come to the briefing on 2 February. They will be able to answer questions on the social work, housing and health aspects of community care, as well as give us information from the point of view of carers. Someone will be here from the University of Glasgow's Nuffield centre, which keeps Scotland's best practice database.

At the last meeting, we said that we wanted to have two experts to assist us with the community care review. The clerks are pursuing that. Once a list of experts has been compiled, there has to be a tendering process. In the next few days, members should make suggestions about people whom they feel should be included on the list. I want the experts to be with us as soon as possible. John Forbes, who assisted in our consideration of the Arbuthnott report, came on board only the day before we first heard evidence. I do not want us to be in that position again. We need to have guidance about how to parcel up our witnesses—for example on whether witnesses should be brought together to deal with one part of the agenda or whether we should deal with groups individually.

I would like members to comment on issues relating to community care.

I agree that we should get out and about to examine good, bad and indifferent practice. However, we should not have the whole committee traipsing about. A reporter system would give us a wider spread.

I have not quite finished reading the submissions, but it seems that we are getting comments from three parts of the country. We should use a reporter system and split up over those different areas. We will get better information from people that way.

We should not forget that the Executive has set up a group that aims for excellence in best practice. We should talk to that group, as there is no point in duplicating its work. We should also advise it of best practice that we find and that way, everyone will benefit. The letter that we received from the Executive ties in with some of the work that we will undertake.

I should have mentioned that. We received the letter only this morning, but I had the first of a series of regular meetings with Iain Gray before the recess—the First Minister has suggested that deputy ministers should be a point of liaison between committees and the Executive. I talked to Iain about what the Executive is doing in community care and the letter sets that out well.

What we are doing in relation to community care should add value to what the Executive is doing. We should not accept that everything that the Executive does is wonderful but neither should we duplicate its work. At our next meeting, the committee clerk will present a new list of priorities that has some sort of chronological order.

Members will see from the letter that we will have work to do on the Arbuthnott report and on Stracathro hospital when we get responses to our comments. Also, we will have to deal with the learning disabilities review. The joint futures group is being asked to consider the question of charging for social work services that are delivered in people's homes. That might make up a large part of our community care review. Having read the letter, I think that it might be useful if we were to produce a report on our interim review that would provide input to the work of the joint futures group. We cannot guarantee that we will finish our review of community care by June, but we should structure our work so that we can comment on charges for home care by then.

There is no point in continuing to do the work only to discover that we have missed the boat, or that we are duplicating the efforts of others.

I do not want to pre-empt our report, but we will come up with several pages exhorting other people to work together to improve community care. We must set an early example and show that we are happy to work in partnership with others to produce a good report.

One thing that has become clear about community care is that there is some dispute about the division of responsibilities between Westminster and the Scottish Parliament. There is some confusion between Government agencies about the balance of responsibility. I asked the research department to produce a paper setting out the current situation, but was told that it could not be done. However, one option that I would be keen to pursue and that is open to the committee, is accessing the research budget so that we can commission the relevant research. We need to know the exact remit of the Scottish Executive and the committee.

Much of the Executive's letter is interesting and important, but we must be careful that the committee does not take on a role that is entirely reactive and in which it merely contributes to the consultation process. As we have already seen, that is sometimes a lot of work for little impact.

I think that it had an impact, Duncan.

I am not sure whether it was the report or its ramifications that had an impact.

Many people who have had some very creative ideas have approached us. One way in which the committees of the Scottish Parliament differ from those at Westminster is that committees can bring forward lots of new ideas. I hope that we can consider that. Perhaps members of the committee can submit proposals for bringing in outside experts and for commissioning research on best practice—not necessarily just from Scotland, but from around the world.

I sent you a note about my final point, convener.

Can I come back to you on that later on, Duncan?

Yes.

I want to pick up on Duncan's point about the demarcation lines on this issue between Westminster and Holyrood. At best they are blurred and at worst, totally impossible to follow. If members wish to leave that with me I will investigate it further. It might be that someone is already doing work on that.

The committee has a range of different budgets available to it. As this is the Parliament's first year, the research budget for bringing in outside experts has not yet been fully used. Any requests for research money go to the conveners committee, which says yes or no and then passes the request to the Scottish Parliamentary Corporate Body. So far, the health committee has spent no money, so I do not see a problem.

Looking at the cold faces of Margaret Jamieson and Irene Oldfather, could some of the budget be spent on heating the chamber?

I think that you have unanimous support on that, Kay.

I would like clarification on whether there is a research budget that is assigned to the Health Committee.

There is not. The committee has access to about one third of one full-time researcher's time. The members of the Scottish Parliament information centre can assist us. We have had some assistance from one of the other researchers on the subject of community care. Members might recall that some months ago, several conveners, including me, made it clear that we do not have enough money or research support.

In the community care responses, some people said things such as, "Your civil servants will no doubt have briefed you on X." People seem to think that we have the Scottish Executive behind us, which is not the case. The research back-up that we have—although the researchers do a very good job—is inadequate for the range of the subject.

Over and above what is available to us in terms of Parliament staff, we are able to bring in outside experts to assist with particular pieces of work, as we did with John Forbes on the Arbuthnott report and as we are discussing in relation to the community care review. A budget is also available to us for commissioning outside work that would be useful to the committee. That is an option that the Enterprise and Lifelong Learning Committee has already taken up.

I know that on several occasions we have raised the problem of the lack of resources to support the committee and I am pleased that we are now able to access the research budget. However, it might be worth making that an agenda item for future discussion, so that we can systematically decide the committee's priorities for accessing that money.

The sub-group on inequalities that Kay Ullrich, Malcolm Chisholm and I are on has discussed what support might be available to the group. It might be that other committee members have other areas of interest for which they will seek support. I would like the committee to discuss that systematically now that we know that the money is available.

We do not have too much time to discuss the future. I suggest that some of the money should be put aside for research into the current winter flu crisis, so that such a crisis can be averted in future. We need an independent view on that.

As I said, I intend to make a suggestion to the committee about that.

I agree with Irene Oldfather's point. It might be useful if the clerk came back with a full document that laid out the various options that are open to the committee.

The Royal Commission on Long Term Care for the Elderly is a good example. We already know what the Government thinks that it can do but we also know, for example, that Age Concern thinks that the Government can do something entirely different. Before we begin the process, it is important to know what we can get out of it.

There must be a base line; we need to know what the Parliament can do in terms of implementing the Sutherland report.

That was a theme—people said that they were unsure about what they could do in Scotland. That is a grey area that affects many people and I think that it would be beneficial to put that on the agenda at some point—it would focus our minds on the issue.

My point follows on from Margaret Jamieson's excellent question. I am slightly confused about the organisation that is being set up.

I am sorry. My teeth are chattering because it is so cold.

The letter that is before us today refers to a Scottish independent commission for the regulation of care and says that that group has been formed. However, the response from the Scottish Executive health department to the Justice and Home Affairs Committee says that

"a Scottish Commission for the Regulation of Care will . . . be established by April 2001 but is not expected to become operational until September 2001."

Do both documents refer to the same commission for the regulation of care?

Yes.

Has it already been formed?

No. A group has been formed to assist in the formation of the group.

They have formed a group in order to form another group?

The aiming for excellence reference group has been formed.

That group sets the standards. The group that Mary Scanlon is talking about is the one that will monitor matters.

The group that will be formed in 2001?

Yes. The independent commission for the regulation of care is the group that will conduct on-going monitoring and licensing of care homes across the board.

Who are the members of the aiming for excellence group?

I cannot tell you off the top of my head who the members are. We can probably find out that information through the clerk.

Is the chamber kept at such a low temperature to encourage us to keep our meetings short?

It could be an attempt to give us all the flu. Are there any comments on the community care review?

Could we have a short break for coffee? It is terribly cold.

I want to say something about flu. After that, Duncan wants to talk about private finance initiatives. That will bring us to the end of the meeting.

Neither of those items is on the agenda.

We are discussing future business; that allows us to discuss those matters.

On a point of order. If the agenda item is entitled future business, we should not use it to go into the past. Although I sympathise with the flu issue, items of current interest have been stopped at previous meetings because they were not on the agenda. The procedures set out in the standing orders must pertain in such situations. I do not think that it is competent for the committee to use the future business item to discuss the flu.

Under the heading of future business, I put on record my view that, at the next meeting, the committee should consider winter pressures. Early in the committee's history, Richard Simpson raised the wider issue of winter pressures. Rather than looking back, perhaps the committee could cast more light, rather than heat, on the situation by addressing winter pressures.

I think that people expect the Health and Community Care Committee to comment not only on the present situation but on the fact that the problem recurs annually. Often there are different circumstances and different levels, but I hope that the committee will agree that we should discuss the matter at the next meeting.

I agree that everybody is concerned about the current situation. I would have raised the matter but for the fact that it would not have been competent, given the committee's previous decisions. We will certainly have an opportunity to voice our opinions this afternoon when Susan Deacon makes a statement on the flu crisis. It would be worth while to include the subject on a future agenda. Unfortunately, the committee's stranglehold has meant that we cannot discuss business as it arises; it has to be on the agenda.

I was simply suggesting that we consider it in the future, rather than today. There may be a ministerial statement in the chamber on the white-hot issue of the day, with the opportunity for members to ask questions, but the committee could ask other people for their input on the wider issue. We had mentioned the whole question of winter pressures, and it would be useful to discuss that.

I refute the use of the word crisis. There is significant pressure, but I do not think that there is a crisis.

Crisis? What crisis?

Crisis? What crisis? The NHS work force is doing an incredible job at the moment.

Absolutely.

However, I want to make a positive suggestion. I would be happy to write a brief paper on the differences between Scotland and England in managing flu immunisation.

That would be helpful.

I may need some support from the researchers, whoever they are. I will need some information to complete the paper.

That is the kind of thing that I had in mind. We read about differences, but we do not know what the real situation is or whether it will have a bearing in future years.

It would be sensible for the committee to meet in September every year to discuss winter plans, winter always being foreseeable. By the time of that meeting, we should have a skeleton outline from the Scottish Executive, although we will not know precise details about flu strains.

Without going into detail at the moment, we know that the current epidemic is potentially life threatening in parts of the country. We could call it a crisis or a mess, but we cannot let it happen again.

Whatever we call it, we must deal with the issue.

We should call it life threatening.

Flu recurs annually in different forms and at different levels. We have problems every winter.

I recall, right at the very beginning, that the committee said that it would not have its programme of work dictated by the newspapers.

It is being dictated by the undertakers.

I resent that. That is an absolutely appalling thing to say; it is scaremongering. Various strains of flu affect individuals and groups of different ages in different ways. For us to say to the people of Scotland what Dorothy is saying is unacceptable. There is a difficulty and we must discuss how such difficulties are to be managed in the future.

Indeed.

We said that we would not be dictated to by the Daily Record, The Scotsman, The Herald or any other newspaper. We must not get sucked into that.

The minister will make a statement today. I agree with Kay Ullrich. We met briefly yesterday to look at the agenda and see whether there was an opportunity to discuss the flu. We both agreed that there was no item on the agenda under which we could discuss it.

I was disappointed that you chose to raise the matter, convener.

I raised it simply because it is a public concern. I agree with much of what Margaret Jamieson said. I want to put the flu on the agenda to discuss in the future and to consider suggestions such as Dorothy's. Perhaps we could ask every year for a report on what the impending winter is likely to bring in terms of health service pressures. It seems reasonable to me that we should try to do that.

I did not wish to indulge in a long discussion about the matter, but I wanted to flag it up as something that the committee ought to consider in the coming weeks. We ought to have input from other people, rather than having a minister say what has happened this year. We should look forward and consider how it fits in with the committee's role. Rather than saying after the fact what people should have done, surely we have to take responsibility for keeping an overview on a number of issues.

We have discussed the matter and decided that we may put it on the agenda for our next meeting.

Not next time—in a few weeks.

Do we really need any further discussion? We have gone on for about 10 minutes each. We will have a discussion this afternoon for all that.

Duncan Hamilton e-mailed me about the private finance initiative. I will leave him to explain his point.

I detect a collective sag of shoulders as I move into this issue.

At one of our early meetings, during which we set our priorities, there were two issues—PFI and drugs—on which we did not know which committee would take the lead. It was agreed that the conveners committee would decide which aspects of those issues would be examined by which committee, and that that decision would be reported back to the committee. I want to know what has happened about that, as I do not want those issues to fall off the agenda.

That probably highlights an oversight on my part. As far as I am aware, the Social Inclusion, Housing and Voluntary Sector Committee is undertaking work on drugs. The Finance Committee and the Audit Committee told me that they did not intend to do anything about PFI.

Duncan Hamilton is right about how we left both of those cross-cutting issues. If the committee is happy with my suggestion, I will find out formally how other committees have progressed on those issues and report back to members. Is that okay?

That is all right.

The Audit Committee has considered the M74 PFI project. It examined a specific project rather than the whole gamut of PFI projects.

We agreed early on—I think that it was in our third meeting—that we would not consider the whole concept of PFI, because that is not a matter for us. I agree with that view, but the implications of PFI for the delivery of health services are very important for this committee. It will be useful to consider PFI in a focused way.

We will return to the matter when we get clarification from the committee clerks of the three committees that are involved.

When I raised the question of drugs, I asked whether it would be possible to have a cross-cutting committee on the subject. Has the Social Inclusion, Housing and Voluntary Sector Committee been appointed as lead committee on it? Frankly, I think that there should be a separate committee on drugs, but I have held off taking any action, such as lodging a motion, because I have been waiting for the response from the conveners committee about whether there would be a cross-cutting committee. Will you clarify the situation, as I have a draft motion ready to be lodged?

I understand that the Social Inclusion, Housing and Voluntary Sector Committee has not started work on drugs, but intends to do so, but I will have to seek clarification on that. There is also a cross-party working group.

There is an all-party group, which Keith Raffan is organising until it is formalised. It has met three times.

There will be a debate on drugs next week.

We might need an update on the work programme that we scheduled in our second or third meeting. Duncan Hamilton proposed work on PFI, I suggested health promotion, and drugs and tobacco were mentioned. Many issues are affected by changes in what other committees are doing. Rather than just reviewing drugs and tobacco, could we have a general update on the issues that we identified initially?

When we discussed community care, I mentioned in passing what I am about to say. I will ask the clerk to present a revised work programme—at our next meeting, if possible—which will take into account what Duncan Hamilton and Irene Oldfather have said, some of the points that the Executive raised in its letter and other work that is being done on the timetable. Now that we have more information, we will be able to pull together a chronological timetable. We have been asking for some of that information—certainly from the Executive—for months, because we thought that it would be useful for our work programme. I thank the Executive for providing a full response that will be very useful, particularly for the community care review.

I do not want to create an extra meeting for the committee, but it would be sensible to meet next on 19 January instead of 26 January. In view of what we agreed about part 5 of the Adults with Incapacity (Scotland) Bill, that change in date would keep us in step with the Justice and Home Affairs Committee.

We are scheduled to meet on both 19 January and 26 January.

Nice try, Malcolm.

Yesterday Jennifer Smart and I discussed the volume of business—there will be some statutory instruments and a couple of petitions—and thought that we could cover everything on one day. That would allow us to hold the financial briefing, which I think should take place sooner rather than later, on the other day. The financial briefing does not need to be a committee meeting, but it requires committee time, so it would be better if members left both those dates in their diaries, while we seek a response from the Executive about the briefing.

It would be helpful to have a fortnightly committee cycle, so that briefings could be held in the alternate weeks. That would allow people to plan their diaries better. I am conscious that there are three years to go. We want to fit in visits to see best practice, for example. Some of us are on two committees, and there are sub-groups on the go. If we start to plan weekly meetings, we will find it very tight to prepare and to do justice to the issues.

I could not agree more. I would love to be able to say that we will never meet weekly, but I suspect that we will have to on occasions. I will try to put back the start times of meetings as much as possible, and to keep to fortnightly meetings, but we have to be aware of the work load that we will face and be as sensible as possible.

I take on board what Irene said about visits. In the community care review we will probably adopt a reporter-type system; visits by reporters can be made in committee time, so that we can cover three or four parts of the country on the same day. We have to make best use of the time that we have available. I will contact members about the dates of the next two meetings.

Can we ask about the venue for our meetings? We are all frozen, and it is obvious that the heating has been switched off. I do not know whether notice about meetings in the chamber is given to facilities management. I want a thermometer in here. Members of the public, too, are affected. There is health and safety legislation about this. It is getting colder in here by the minute. It is unacceptable.

Absolutely. I offer our apologies to members of the public in the public gallery. I will paraphrase my colleague by saying that at least the hot air that we expend rises towards them, but I am sure that that has not taken away the chill factor up there—I am not sure whether that chill factor entitles people to any special payments. The health and safety point is well made, and we will raise the matter of facilities in the chamber again with the corporate body. We have had the same problem with heating every time that we have met in the chamber, but this is probably the worst yet.

Nobody will have a grain of sympathy with us. One or two schools in Glasgow have refused to continue because classrooms are too cold and kids have had to be sent home. Who will bother about politicians?

There are regulations. I hope that they are enforced.

I will bring the meeting to a close.

Meeting closed at 11:35.