“NHS in Scotland 2015”
Item 3 is responses from the Scottish Government and Audit Scotland on the Auditor General for Scotland report, “NHS in Scotland 2015”. I ask colleagues for their comments.
I do not quite understand one of the comments in Mr Gray’s response, which refers to
“demand at A&E departments continuing to increase”.
I have printed off the Information Services Division reports from April 2010 to November 2015 of the attendances at accident and emergency, and at no time between April 2015 and November 2015—that is the last monthly report that we have—was the number of attendances the highest for that month in the past five years. If you look across the years at the month of April, you see that the highest number of attendances was in April 2011. For the month of May, the highest attendance by quite a margin was in 2010; in May 2015 there were 138,077 attendances, but in May 2010 there were 149,538.
It is not indicated that some of the problems that we are experiencing in accident and emergency, which were again evident in last week’s report—now that we get weekly reports—are due to an increased level of attendance. There may be other reasons for the problems, but an increased level of attendance is not one of them. I have tried to look back at the Auditor General’s paper and I cannot see that it suggests that there is a substantial increase in demand, so why was the question of increased demand raised?
My second point is that I put in a freedom of information request to all the boards about the alternative access routes. That arose from the problems that we were having at the Queen Elizabeth university hospital with the so-called acute assessment unit, which is a different route by which patients can come in and which is not subject to waiting times targets or even any sort of monitoring. In fact there is a huge list of such units, which I can supply to the committee. Those are called various acronyms—CPDUs, GPAUs, MRUs, SAUs and, in the Highlands, RAMA, whatever that is. I could go on and on. Each of the boards has alternative assessment units, some of which have a four-hour target but most of which do not have a target at all.
The situation for accident and emergency is a lot more complicated, and I wonder whether other members feel as I do that we are not getting a clear picture. Many acute assessment units, which are also known as intermediate assessment units, although there are, as I have just highlighted, lots of other names for them, have grown up since the waiting times scandal of 2011. They may be being utilised appropriately or inappropriately, but I am not convinced that they are a part of the system that we understand fully.
Before I bring in Mary Scanlon, I ask colleagues to give an indication on how they wish to progress our work on the issue.
I want to ask for further information in order to get clarity. I wrote down the words “fudge” and “waffle” after I had read Paul Gray’s letter about three times.
We had asked for information on Audit Scotland’s submission to the committee on accident and emergency, as well as on targets and the purpose of assessment units. In the third paragraph of Paul Gray’s letter to the convener, he states that he does not know the reasons for the referrals. He states:
“We do not collect specific data on number of referrals or reasons for referral”.
We understood that the acute assessment units are not subject to the four-hour A and E target and that they are a way of sidelining the target.
I remember clearly that a previous Audit Scotland report to us had a page setting out who referred people to accident and emergency departments. It was general practitioners, the Scottish Ambulance Service and NHS 24. Our concern as a committee—Hugh Henry was then convener—was the huge increase in self-referrals. We were trying to understand that better and we spoke to ISD and others about the matter. I am not satisfied with the information that we have. It does not fully answer the questions that we were asking. The Audit Scotland report set out what percentage of A and E visits were self-referred, and the number has increased hugely on previous years. I do not accept that the director general of health and social care does not have that information given that we have had it in a previous report.
To follow on from Richard Simpson’s comments, it would be interesting to see what figures Paul Gray has. If we are to consider the matter, we need to have sight of all the figures.
Looking at the “NHS in Scotland 2015” report, I think that the backlog maintenance issue is answered fairly well. Leaving aside the possibility that we may ask Paul Gray to provide one or two pieces of information, we have probably gone about as far on the issue as possible, given the stage that we are at before dissolution.
I do not totally agree with that.
I remind members to be clear about the information that they want.
The Government has previously given us targets for dealing with the high-risk backlog maintenance. Those targets were not met. I want to see what the current targets are and when they are likely to be met, so that the successor committee can hold the Government to account.
We have a definition of “high risk” from the Auditor General. That includes the possibility of considerable clinical risk. That concerns me; we should be carefully looking at the matter. This is, obviously, a moveable feast—new items will be added and there will be a redefinition from significant to high risk as time progress. We must understand what is happening in far greater detail than has been provided to us if we are to do our job in protecting the public.
We are clear on what further information is to be sought from Paul Gray. It would also be helpful if Richard Simpson could provide the information to which he referred.
I will pass it to the clerks.
Is it agreed that we will seek further information?
Members indicated agreement.
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