Item 3 is evidence from the Scottish Government’s bill team on the financial memorandum to the Patient Rights (Scotland) Bill. I welcome Lauren Murdoch, bill team leader; Margaret Duncan, policy lead for the treatment time guarantee; Fiona Montgomery, head of the patient support and participation division; and Alastair Pringle, head of patient focus and equalities. I invite our witnesses to make an opening statement.
The Patient Rights (Scotland) Bill establishes in primary legislation key provisions to put patients at the heart of the national health service in Scotland, including person-centred principles, support services and a treatment time guarantee. To support staff and to help them to understand the rights of patients better, the Scottish Government is funding training and education materials and awareness raising through induction and continuous professional development that is costed at £94,000 this year and £800,000 in each of the next two years. The patient advice and support service, which will be staffed by patient rights officers, will build on the work of the current independent advice and support service, which is provided for health boards through contracts that are negotiated locally with citizens advice bureaux.
Thank you. I invite questions from members.
I think that people would definitely support the objectives of the bill. However, having read the evidence from health boards, you will be aware that they are concerned that the costs may be greater than has been stated. Obviously, the context of that is more difficult budgets than the boards have known for a few years.
On training, we have been speaking to representatives of NHS Education for Scotland, which delivers all the education materials and so on for the NHS. We are getting involved in pre-registration training, induction training and other training, rather than taking some people out every day to do a whole day away from their normal duties.
Given the 150,000 staff in the NHS, it would cost a lot more to offer any coherent programme of work around person-centred care than is set out in the bill. NHS Education for Scotland provides an opportunity to develop a national set of principles and training, with a consistent quality of materials and provision throughout the NHS, including in remote and rural areas.
Your second point was on advocacy. We are spending some money this year to find out what is actually happening on the ground and to ascertain whether there are any gaps. The money will then go towards addressing those gaps, which might not be the same across all boards.
This year’s funding is £70 million, and that is recurring funding—that will go forward next year.
I suppose that that covers most of the matter. NHS Ayrshire and Arran has had to put in some non-recurring funding, but I do not know how typical that is of other health boards. NHS Ayrshire and Arran, at any rate, says that it will face an additional cost each year. What is your comment on that?
There are problems at individual boards, which might need to put in some extra capacity. However, we will continue to deal with that through the support and delivery of the 18-week referral-to-treatment time. The issues around the financing of that and the treatment time guarantee will continue to be discussed in order to ensure delivery.
So the requirements could be a bit more and, if so, you will just have to cover that, as the target is so important.
Yes, although the £70 million has not yet been allocated. We are in discussions with boards on the appropriate allocations.
As you have clarified, there has been some ambiguity about how many patient rights officers would be required. There was a discrepancy between the policy memorandum and the financial memorandum in that regard. You quoted the figure of 65 to 80 officers; I think that that is from the financial memorandum. I suppose that the boards are concerned about that, too—perhaps it is the biggest area of concern, in some ways.
Although the service will be different from the current independent advice and support service, we arrived at the figure by looking at current case worker costs and basing our look forward on that. With procurement people in NHS National Services Scotland, we are looking at the specification of a national contract for the future. That is partly because there have been inconsistencies in the quality and amount of service across boards. We are trying to make that more consistent. We have looked at the numbers and, as the contract is worked through and we discuss local needs with boards, we are trying not to be too specific by saying that we need X number of patient rights officers in every board. We are allowing for a bit of leeway, which includes how much the organisation that will get the contract wants to spend on marketing, central support and so on. That is why we have tried to cover a range of figures.
A number of organisations have expressed concerns about the financial memorandum. For example, Citizens Advice Scotland has indicated that it cannot see any provision for inflation or salary uplifts over a three-year period. Clearly, if that was the case, that would be a pretty substantial real-terms decrease in the money available over three years. Secondly, CAS said that there does not appear to be any marketing budget for the new organisation. Given the nature of the work that the organisation will do, one would think that marketing would be pretty important in bringing the service to the public’s attention and making people aware that this is a route that they can take.
On inflation and salaries, we have produced a package with an amount that we think will take us forward. Obviously, though, we are still in discussion about the exact specifications of the contract; costs may be slightly less in the first year, which would allow a bit for an increase for inflation in future years. However, we are still working our way through that.
How can you ensure value for money and how would you measure it?
It is very difficult to measure value for money in this area. There is quite a lot of evidence about improving a patient’s experience and about information that has an impact on a patient’s health care and health outcomes. We tried to quantify the amount in our work on the regulatory impact assessment. We can do qualitative work and talk about a case study in which we can see that, if somebody is better informed about their health care, they may be better at, for example, taking their medication and attending consultations.
I am pleased to hear that you think that savings might be made, but most major health boards that have given evidence expect not savings but increased costs. What consultation have you had with boards about the bill’s financial implications and particularly about the concerns in their submissions?
We have consulted boards all the way through the bill process. The bill was introduced in March, but consultation took place for some time before then. We have talked to national boards such as NHS Education for Scotland about contracts to do pieces of work—that board has given us its estimate for the work. We have spoken to the territorial boards—the local boards—throughout the process and we continue to speak to them and a range of stakeholders.
We have spoken to several chief executives at their regular meetings with the Government. We have also met patient focus and public involvement representatives as part of general work on patient support and participation.
I will quote just the submission from NHS Lothian, for example. It was asked the standard question:
On patient rights officers and the patient advice and support service, we ask boards only to continue to provide their current funding level for the independent advice and support service. We will fund centrally the additional costs.
So somebody might just change their job title. Do most health boards not have somebody who deals with complaints?
Patient rights officers are independent and do not work for boards. Case workers who currently provide such a service are employed by citizens advice bureaux. Under the new system, the contract will be open—we do not know who the supplier will be. In response to the consultation, patients and stakeholders said clearly that they wanted an independent advice service and that they wanted to approach somebody who was not employed by the health service. No matter how good and helpful a complaints officer might be, some people wanted independence at some point.
Are you confident that enough is being allocated to help with the staff training that Mr Pringle mentioned and that boards will not have to carry an extra burden in the end?
We are packaging that training with a range of other training on the NHS quality strategy that was launched recently, on equalities and on human rights. NHS Education for Scotland has told us that it can deliver the package of materials, which we can embed in staff training.
The costs were based on the previous experience of NHS Education for Scotland in delivering similar NHS-wide programmes of work, such as the patient safety programme. We are fairly confident that the costings are accurate. We would not necessarily expect any additional cost to health boards if we are building the training into the existing programmes and delivering it through existing training and practice managers networks and the like. We are quite confident that the networks and infrastructure are in place to deliver the training.
I want to pin down exactly how many patient rights officers there will be. Is it 40 to 50, or 60 to 80?
The 40 to 50 would be the additional ones, with the additional central funding. There are already 30 or so independent advice and support service workers. The 40 to 50 are the additional workers that we could provide with the £1.25 million from central funding.
On central funding, NHS Lothian said:
Perhaps Alastair Pringle could say something about NHS inform.
I thought that the point was valid. We are doing some work on national quality assurance and the accessibility of information through NHS inform, which is the new national patient information service. Over the next year, a bit of work will be done with health boards to look at how we co-ordinate and ensure better efficiency and effectiveness in the translation of materials centrally. That work is under way.
I see that there will be quite a bit of money for the bill in 2011-12 and 2012-13. How do you know that you will have that money?
We put this forward at the end of March. We recognised that within the health care strategy and policy directorate we would be able to find the money by reprioritising work because certain things will be coming to an end and so on. Obviously the budget situation gets tighter as we look forward. We still think that we will be able to deliver, but we will have to consider it if things change in the overall budget for health. I would not like to say that the amount of money involved is modest, but it is quite small in the scheme of the health budget. Assisting patients to access front-line services is seen as a priority area.
So, whatever happens in the spending review period, this spending is set. You have been told by ministers that it is an absolute priority to have 40 to 50 additional PROs, rather than nurses, for example.
We do not know what the spending review will provide, but the best that we can say at the moment is that these figures are what we are working to. As with all things, as we work our way through, we will look to see whether we can get the same outcomes for slightly less or get better value for money elsewhere.
Previously, when the committee scrutinised the health boards elections pilot, the Health Boards (Membership and Elections) (Scotland) Bill team told us that they could not give us any indication of expenditure post-2011, because that is in the spending review period and it is out of their hands. Here, the expenditure seems to be quite set. I do not know which is—
The figures are the current projections. On the financial memorandum, we are usually asked to look three years ahead. This was the best that we could do with the information available to us.
I turn to some of the bill’s other impacts. One of the big elements is the impact on Citizens Advice Scotland, given the services that it currently provides. Forgive me, because this might be in the papers, but I could not see it: has a regulatory impact assessment been carried out and, if so, what was its conclusion with regard to the impact on an existing body operating under contract?
A regulatory impact assessment has been carried out. I cannot give the exact figure for that, but we can certainly pass on any information that we have.
Perhaps the information can be submitted in writing to us afterwards.
Certainly.
Does the financial memorandum or policy memorandum mention that a regulatory impact assessment has been carried out?
Possibly not, but a regulatory impact assessment has been carried out.
Why is that not mentioned?
I am not sure.
The financial memorandum makes a brief mention of the regulatory impact assessment.
What did the regulatory impact assessment conclude about the proposal to remove the contract from the organisations that currently deliver those services?
The regulatory impact assessment primarily looked at the impact on patients. It did not look at the impact on the contracts with citizens advice bureaux, which are due to come to an end anyway.
NHS National Services Scotland is looking into the contract, including whether arrangements under the transfer of undertakings and protection of employment regulations will be required. As Lauren Murdoch has referred to, some of the contracts started in 2006 and some of them started in 2008 but we have extended them all to the end of March 2011. That is the specific timescale.
I see that paragraph 64 in the financial memorandum states:
I would need to go back to look at the NES workforce plan, which I am not familiar with. We can certainly provide that information later.
Yes, those are very detailed questions. It would be helpful if the committee could be given that evidence in writing.
Thank you, convener. In essence, the point is that every health board is projecting reductions in staff numbers, including in the number of clinical staff posts, whereas the bill will require that further investment is made in additional PROs. Indeed, NHS Greater Glasgow and Clyde—I refer to paragraph 4 of its written submission—suggests that the £831,000 for patient advice and support services is an underestimate. The submission states that, of the £831,000 recurring cost,
The £831,000 is what all the boards told us they are paying for their contracts in the current year. If NHS Greater Glasgow and Clyde is paying slightly less than what might be expected from its population average, perhaps that shows why we are moving to a national contract, which should provide a bit more consistency of service.
NHS Greater Glasgow and Clyde’s concern is that, because of the size of the health board area,
For the patient rights officers, the additional money from the centre will be spread out across the boards, based partly on how the national resource allocation committee allocates funding but more on how the contract works and on the local needs of the different boards. The funding may just continue at the current level.
We have reached the end of our questions. As you have no final comments to make, I thank you for your attendance and for the evidence that you have given us, which will be helpful to the committee.