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“Managing the use of medicines in hospitals—A follow-up review”
Item 5 is a section 23 report. We have received a response from the accountable officer on the Auditor General's report "Managing the use of medicines in hospitals—A follow-up review". Do members have any questions or comments on the response?
I am a wee bit concerned about the answer to our second question. If I remember our discussion on the matter correctly, everybody thought that the system that is used in NHS Ayrshire and Arran is a good one that should be rolled out if it is proven to be able to do the job. However, the responses to our first two questions say that, even if work is done to prove that that model could work throughout the NHS in Scotland, it will still be up to each health board to decide whether it wants a stand-alone system. I am all for local democracy and people taking decisions at a local level, but those decisions must take cost effectiveness into account. If we have put in a lot of work, nationally, to find out whether that is a good system, I do not see the clinical or cost benefits of telling boards that they have the choice to go with the system that we recommend or to pick up a system of their own. Am I right in my understanding of that response? Is that what it is saying, and is that the best use of resources to date and in the future?
The response talks about health boards following that example if they feel that the business case is proven. It states:
I do not think that we did. One of our problems is that, although in considering the report and following it up we are commenting on the use of resources, we are starting to talk about clinical and policy issues. We might need to refer the matter to the Health and Sport Committee for its consideration, because it would not be appropriate for us to go into detail on whether, from a practice perspective, the proposed approach is the right way to proceed. We have made some comments on effectiveness and efficiency. We must tread a fine line.
I understand what the convener says. In fact, that is one of my constant frustrations with the Public Audit Committee's remit.
I do not know whether anyone from Audit Scotland can throw any light on the matter but, again, we need to be careful not to go beyond our remit, which we will do if we start to examine clinical practice policy.
The team has just passed me a copy of the supplement to the follow-up report, which contains a paragraph that might be helpful. It might be that the issue is to do with the nature of the information that is communicated. The HEPMA system is a general system for hospital prescribing, but a paragraph in the supplement to the follow-up report talks about
A number of options are open to us. We could go back to the accountable officer and ask for further information, should we need it. We must also decide whether there is an issue for the Health and Sport Committee to consider. Is there any information that members would like Kevin Woods to provide?
When we discussed the report, it emerged that a huge amount of money was spent on medicines in hospitals. I worked out what percentage it was of the total block grant, but I forget the figure. There is a great potential for saving, given what is said in the excellent report that we received from the Auditor General. However, all that we have done is send a letter to the accountable officer, who has given us—I do not know why Andrew Welsh, who usually says these things, refuses to comment—just a lot of verbiage that does not deal with all the points that we raised.
I am inclined to agree with what the convener said. It is clear from the report that a patient management system is being rolled out, given that the contract for it will be awarded in the autumn. From my reading of the report, there is scope for boards to choose whatever is appropriate to their situation. That is a matter for clinical judgment, of which we need to be respectful. Progress seems to be being made in gathering information and on prescribing mechanisms, but the clear message from the response is that the decisions should be based on clinical judgment, which can be applied more appropriately by boards. I am quite happy with that.
I agree with that. The great danger is that we end up in a position of telling boards what their policy should be. Cathie Craigie mentioned the need for cost effectiveness, which is what we hope systems will achieve. The response states:
Do we require additional specific information from the accountable officer? If not, I suggest that we note the response and refer it to the Health and Sport Committee for its interest. If we need further information, let us ask for it. I am in the hands of committee members.
I think that Andrew Welsh has been Nicola-ed.
Will George Foulkes explain that? It is news to me.
He can explain it outside the committee.
I can assure the committee that I have not been got at by anyone.
Let us leave all that aside. Do we require specific further information from Kevin Woods?
“Drug and alcohol services in Scotland”
Item 6 is consideration of a response from the accountable officers on the Auditor General's report "Drug and alcohol services in Scotland".
I do not think that it is worth saying anything, because we will be told that such matters are not for this committee.
I do not think that that is fair. Some thing are relevant for this committee, but we should not go beyond our remit into—as happened under the previous item—issues of clinical practice and policy, which are not matters for this committee.
Given the response from the accountable officers, much of this is clearly work in progress that is at an early stage of development. Perhaps, rather than pursuing the matter now, we should come back to it in six months' or a year's time and ascertain what progress has been made by then. Perhaps it is a matter for the Health and Sport Committee. It would certainly be within our remit to return to the accountable officers in six months and ask where they have got to with all the answers.
I would certainly be interested to know what the starting point is for their measurements. Otherwise, we will not know whether progress is being made. For example, do we see anywhere the number of residential placements that are to be made available, which is apparently a fundamental part of the policy? Can anyone from Audit Scotland help us with that?
The response outlines the anticipated plans for drug and alcohol services, but the committee is raising specific concerns about those services, as does Audit Scotland's report. The response leaves quite a few questions outstanding about the detail of what is happening. There are some long-term plans, but some immediate issues could be addressed now. There is a lack of clarity about what is being done now, and it might be interesting to explore that.
Could we go back to both the accountable officers, Robert Gordon and Kevin Woods, and ask for some further detail, so that we can make an informed comment?
Members indicated agreement.
“Central government's use of consultancy services—How government works”
Item 7 is on a further section 23 report. We have a response from the accountable officer on "Central government's use of consultancy services".
No, we do not. We can find out and let you know, but I cannot answer that question at this point.
Okay. Are there any other thoughts or comments on the response?
This is on the committee's second question, about approved suppliers of consultancy services and so on. I was interested in the response on why the Government chooses a framework system, rather than approved supplier lists. The response says:
Presumably, if someone is chosen from an approved supplier list, they will also have to satisfy the framework contract, establishing their pricing and conditions, or are the two things mutually exclusive?
The general recommendation in our report was that greater use should be made of framework contracts, for the reasons that are given in Stella Manzie's response, which says that
That touches on a theme that we have visited on several occasions, regarding whether we are getting value for money. That can be established only by assessing what we get in the end. If someone does not provide good service, I imagine that they will be neither on an approved supplier list nor signed up to a framework contract. That element must be there. I would like some clarification as to whether that part of the assessment process is carried out at the end of a given piece of work.
We can go back to Stella Manzie and ask for that further clarification. Otherwise, we note the response.
I make just one further point in the passing. I note from the response that the civil servants are going to have some awareness raising of the rules that apply to them when they take on posts as consultants within two years of retirement. I suppose that that awareness raising is to be welcomed.