“Reshaping care for older people”
Item 4 is a section 23 report on reshaping care for older people. The report looks at the progress three years into a 10-year programme, and the Scottish Government has committed to provide further information on some of the committee’s recommendations once on-going work has been concluded.
I invite questions and comments from members. We have various options. We can note the responses, require further oral or written evidence, highlight issues to the Health and Sport Committee, or ask for a progress update on any report recommendations in the next Scottish Government progress report, which is due in May 2015.
This was quite a worrying report from the Auditor General. As I recall, the comments were that there is limited evidence of progress being made and that, instead of resources being shifted from the acute sector to community care, the community care budget is going down and the acute sector budget is going up. We have heard evidence that the sector is under a number of policy pressures. As well as the reshaping care for older people programme, the biggest one is perhaps waiting list targets, but there are other priorities. We might say that those targets are not being met, but that is a separate issue. It was felt that progress is not being made and that therefore the situation is unsustainable.
11:30
There are concerns. Exhibit 11 in the report illustrated that, of the eight commitments, progress has been made on only three. However, I appreciate that we are three years into a 10-year programme, so we need to take that into account.
Exactly. We have already had an evidence session on the issue with Paul Gray, so I do not see much point in going back over the issues. However, paragraph 7 of the response makes the promise that the Government is
“working to develop indicators and outcomes for integration”
and will come back to the committee on that next year.
To be honest, although we have concerns and we have aired them, I am not sure that the response entirely addresses them, because it just talks about what is already happening, although clearly that will make a difference. However, as the Government is going to come back to the committee, I am happy to wait for that.
I think that we will receive a progress report. We have done our own report on the issue. We cannot truly expect all eight recommendations to be met within three years, but we are looking at progress, and I appreciate that it is disappointing.
Let us remember that an additional £100 million has gone into supporting health and social care partnerships and so on. One issue that came up at the committee is the integration of local data to help to manage the processes better. Page 3 of the Government response refers to the rather catchily titled health and social care data integration and intelligence project, which will
“enable every local authority to link social care data with health data”.
An issue that comes up from time to time is about how the different systems in areas of responsibility that were previously sort of independent are now coming together. Of course, it is a burden to bring together the data to manage that. I am pleased to see that comment, but I do not underestimate the difficulty that that could involve, particularly when, for example, general practitioner systems across Scotland are different and are all over the place. I wonder how the health boards and local authorities will proceed with that. I am happy to keep an eye on that and get progress reports as things develop. That is a crucial issue—it is about data management and doing it correctly for patients.
I could not agree more.
Basically, we have some concerns.
The general thrust of my comments is that we need to come back to the issue at a later date. For me, paragraph 2 is one of the key paragraphs in the response, as it highlights what the Government is trying to do to shift the balance of care and the various methods that it is trying to employ. The paragraph goes on to suggest that savings might be available in the acute sector because of that. I for one am not convinced about that. There might be savings, but the money will not necessarily transfer to care in the home, given the huge pressures that we all know are on the health service. Although there might be savings in the acute sector, the money will not automatically go to other parts of the service, as it might have to remain in the acute sector to allow it to continue to deliver. When we get the update, I would like to understand where any savings that are identified will be applied.
Your comments are on the record. We do not underestimate the complexities of the issue.
Are colleagues content to note the response, given that we will receive a Scottish Government progress update in May next year?
Members indicated agreement.
“Managing early departures from the Scottish public sector”
Our next section 23 report, on managing early departures from the Scottish public sector, probably has Kenneth Macintosh’s name all over it. We have received evidence from the Scottish Government on the Auditor General’s report. I invite questions and comments from members on the issue. As I named you, Kenneth, we will go straight to you.
I remind members of the evidence that we have taken on the issue. The Auditor General produced a report that flagged up weaknesses in the approach to early departures. In evidence taking, we explored further difficulties with the use of confidentiality or gagging clauses. Initially, we got a rather unsatisfactory response from the head of the civil service, but the Government says that it is going to change its practice and its policy. The difficulty that we have is that the Government said that it had a policy of not using confidentiality clauses in the national health service but we know that not only does it use them, it uses them in virtually every case and the use of such clauses has been growing every year. The worry is whether we have the ability to monitor the commitment not to use them.
From now on, the Government will report on the matter annually to Parliament, and it has expanded the number of bodies on which it will report and will collect the information centrally. That is to be applauded, and I look forward to receiving those reports. The only point that I would make is that, although the Government will report on settlement agreements, it will not report on voluntary redundancy which, as members can imagine, is one of the biggest schemes and one of the biggest costs.
Given what we heard under agenda item 3 about the redundancy programme for senior management at colleges, it is extremely important that Parliament can at least cast an eye over, if not ask further questions about, how much money is being spent on redundancy, because we are talking about huge sums of money—hundreds and hundreds of millions of pounds. The second part of the issue is confidentiality agreements.
We should bear in mind that, although the Scottish Police Authority is covered, Police Scotland is not—in other words, settlement clauses and redundancy payments for police officers are not covered. There have been a couple of cases, which have been widely reported, of officers leaving and being given very generous settlements, and then being re-employed a matter of weeks later. The situation is similar with universities. I am pretty sure that colleges are covered but universities are not. We should bear that in mind.
Otherwise, I am happy to note the submission and delighted that the Government is to report to Parliament.
I agree with you—I think that we have moved forward on the issue. There is now a presumption against the use of confidentiality clauses. It is fair to say that there is more transparency, although whether there is enough is another matter. The Auditor General is in the room, so I am sure that she will have noted what you said about Police Scotland.
I agree that we should note the submission, but Ken Macintosh made some pretty sweeping statements and, without looking at some of the numbers, I am not prepared to accept what he said as far as the health service is concerned. I would need to look at the figures. Because Ken Macintosh says something, that does not make it right.
It was the Cabinet Secretary for Health and Wellbeing who made the remark in question.
I think that Ken Macintosh was talking about the historical situation. We are moving forward.
But the main point as far as voluntary exit schemes are concerned is that, as is made entirely clear in the letter that we got from the head of the civil service,
“The numbers of staff leaving through voluntary exit schemes and the associated costs are reported in the consolidated annual accounts for each public body. They are ... reported centrally to Parliament.”
Therefore, there is oversight by the Parliament of that aspect.
I remind members that, at the end of our meeting on 5 November, the Auditor General confirmed that she would report back to the committee with further information on the number of settlement agreements and the use of confidentiality clauses in the NHS, along with any concerns raised by local auditors.
I would like to correct the record, because I made a mistake—I missed out the word “not”. I should have said:
“They are not reported centrally to Parliament.”
However, that information is available in the annual accounts.
There is more transparency; whether there is enough transparency is another matter.
Do members agree to note the submission, bearing in mind the fact that we will receive a further report from the Auditor General?
Members indicated agreement.
“Modern apprenticeships”
The next item is a section 23 report on modern apprenticeships. We have had written submissions from Skills Development Scotland and the Scottish Government. We took evidence from SDS as long ago as 28 May, following which we sought clarification from SDS and the Scottish Government on several issues.
Are members content to note the submissions, or do we wish to seek further written or oral evidence? Do members have any questions or comments?
I would be happy to note the submissions.
I think that the issue is also being discussed at the Education and Culture Committee. Do committee members agree to note the submissions?
Members indicated agreement.
We are doing a real mopping-up exercise today.
“Self-directed support”
Item 7 is a section 23 report on self-directed support. There is a 10-year strategy running to 2020, and the Auditor General, having reviewed the early progress, gave a commitment to continue to monitor the strategy as part of her work on the NHS. It just so happened that I was talking last night to a social worker from Fife who said that a lot of progress is being made on the ground. However, there are still six years before the strategy will be fulfilled.
Are there any questions or comments? Do members wish to note the report or to seek further written evidence?
There is clearly a major change taking place in our communities and services, which I think has the support of all the parties that are represented in the Parliament
Yes—from all the parties.
However, it is also quite a painful change. There are two processes going on simultaneously. There are budget cuts, and there are also changes to self-directed support, and those are happening at the same time. Sometimes, it is difficult to tell what is happening.
A lot of day care services provided by local authorities are being closed, and people are not using their own budgets to purchase such services. It is quite a traumatic process for some.
The letter that we have received is particularly useful, as it tells us how the Government is going to collect information on the matter, including, I note, a
“Survey regarding the views and experiences of social care users and their carers.”
That will be very useful. I am sure that the Health and Sport Committee will appreciate that, as will we when we return to the matter in about a year or whenever it is.
It will be worth coming back to it, and I highlight the complexity of the merging of the health and social care budgets, which Willie Coffey has mentioned previously.
I am delighted that everybody supports the strategy. I am happy to hear that you were speaking to a social worker last night who was happy with it. It is a great thing. However, it would be nice if there was a more uniform way for local authorities to implement it. There seem to be huge differences in the ways in which local authorities are taking SDS and running with it.
Ken Macintosh has mentioned day care centres. When the cost of day care centres is raised to a fairly exorbitant amount, that presents a disincentive for people to use them. Local authorities should think carefully about that.
You are absolutely right. I used to monitor how many local authorities gave direct payments. That went through in accordance with the Community Care and Health (Scotland) Act 2002, which was passed in the first session. Fife was always the leader with direct payments, and the social worker I met last night was from Fife, so perhaps they are in the lead there. Committee members are right that the matter is worth monitoring, and it is quite a complex issue. Many changes are happening just now.
Are we content, for the time being, to note the submission?
Members indicated agreement.
We will now move into private session. I thank all members for their forbearance as I stand in for our normal convener, Hugh Henry.
11:43 Meeting continued in private until 12:20.Previous
Section 22 Reports