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This is an important committee, which deals with life and death issues. Health is consistently the number one issue for people in Scotland. In the months and years to come, we will debate and make decisions on some important issues, including not only questions of finance and questions about what topics we want to cover—we will discuss that shortly—but the position of staff in our health and community care services.
I wish to raise two matters: our substantial range of issues and the way in which the committee will work. I have a number of questions on the remit of the committee, but I am not sure if you want to address them now, or hear them and return to them at a later stage.
We will hear them now, and if we can answer them, we will. If not, we will come back to them.
Obviously, one of our big issues is finance. Part of the committee's remit is
I understand that we can examine all of those things.
Does the remit apply retrospectively? If so, it would seem to be a logical extension for the committee to look at the value that is being delivered at the moment.
I am told that the committee can do that.
I am not too sure about that. I am not saying that we should not discuss the important issue of PFI, but I think that the Audit Committee had the prime responsibility to take a retrospective view. This committee's concern should be whether PFI can, or will, deliver good health care. In other words, the committee should take a strategic view on operational matters related to health policy. We will not be the lead committee on matters of finance: that will fall to the Audit Committee under the chairmanship of Andrew Welsh.
Obviously there is a spillover between the financial aspects and the impact on staff.
We will have to investigate the retrospective issue, but I told the ministers that PFI was one issue that the committee might want to discuss today. I did not get the impression that they thought the committee would not examine PFI—quite the opposite. We can get clarification on that for the committee.
We need clarification not only on the retrospective aspects, but on our future inquiries into whether PFI is applicable. It would be damaging if all committees start to investigate all aspects of everything. In other words, if we cease to have committees with very specific responsibilities, we will end up with committees doing nothing, rather than doing something well.
I agree. I do not envisage that the Health and Community Care Committee will be the lead committee in looking at PFI: the most important committees will be the Finance and Audit Committees. However, there are issues for us concerning how we deliver the best health care and how we deliver the best conditions for the staff in the health service. Although the committee will be interested in PFI, I would like to see us moving forward with the positive agenda of trying to find some areas in which we have broad consensus. We need to deliver something positive early on, which people can say is an in-depth inquiry undertaken by the health committee, and which makes progress on the topics and issues that matter within health care, rather than tackling the broad umbrella subject of PFI.
I would like clarification on the Minister for Finance's statement on Thursday, and on the Treasury's announcement of Alan Milburn's measures regarding PFI and the transfer of pensions. Will the measures apply in Scotland? If so, a lot of the concerns of low-paid workers will be removed, particularly those of health service workers, who were the ones at risk following transfer to private contractors. I would like that to be one of the first issues addressed, because I have represented individuals in the health service, particularly ancillary workers, for the past 20 years, and I am well aware of their concerns when they have to transfer to private contractors.
I will go out on a limb and say that probably everyone on the committee shares that point of view.
It would be entirely appropriate for us to examine the staffing issues of PFI. There is no point in our covering the whole agenda, but we all want this committee to be involved in as much consultation with as many so-called experts and as many of the people of Scotland as possible. Many radical health policies suggest that involving as many people as possible must be at the cutting edge of health policy.
That takes care of two years' work.
One of my passions is food—not eating it, but talking about it—and food may be one way of addressing public health, for example, with regard to income inequalities.
That is a good point.
I will go along with what appears to be the majority view—that we will not be playing the pivotal role in PFI—but I imagine that this committee will want to examine how PFI affects staff in the health service.
Do you have any other matters that we should address?
We should address community care. Anyone who has gone through an election campaign knows that that issue is raised time and again on the doorsteps. There are problems with the funding of community care. Local authorities are struggling to fund it. Problems in the interface between social work and the health service must be looked at. I am greatly concerned by service delivery by postcode. The amount of funding that follows the patient into the community can vary hugely between health boards, and there are huge differences in the types of services available, depending on where people stay.
That is very good.
This committee is responsible for one third of the Scottish Parliament budget and we have enormous challenges ahead of us. I do not disagree with anything Hugh Henry said; we had an open and honest debate about PFI in the chamber and I do not want to spend the precious time of the committee on number-crunching and deciding on the whys and wherefores of PFI. None the less, I hope that if we feel that a particular PFI project impacts on front-line patient care or that it has taken money away from patient care—it is patients that I am concerned about—members of this committee will make our representations to the Audit Committee. I agree with Hugh Henry: PFI is such a big topic that every committee could spend hours debating it. I would prefer to rise to and meet the challenges that are ahead of us.
Long may it continue.
I share Kay's concern.
So much so that she is going to agree with the SNP.
I am actually going to agree with the SNP. We must consider the care of the elderly; it impacts on many areas, such as bed blocking. There is not as good a relationship between the social work departments and the NHS as there should be and there is also some concern that private nursing homes and council nursing homes are not treated equally. Care of the elderly is a far greater remit than dental decay, but I would like us to address it seriously.
In case members did not mention various items, I made a sweep-up list that I intended to refer to at the end. It includes the issue of rural health services and, as Kay said, health services delivered by postcode and the need to level the playing field for the patients of Scotland no matter where they live.
I want to pick up on what Kay and Mary said and focus on care in the community. The joint investment fund is an untapped facility that interfaces between acute and primary care. I want to investigate whether we can expand on it. I would be interested primarily in best practice—the way in which it interfaces with social work, voluntary organisations and the health service—because personal experience suggests that it is not working as it was intended to. It is supposed to provide a service. We could gather evidence from all the bodies that fall within the JIF, as it is called, because it is certainly not performing as it should.
This committee has a unique opportunity to affect the lives of Scottish people. I hope that we will develop that in a positive and constructive way. Far be it for consensus to break out in the last week before the recess, but it looks as if it might. I am very pleased to be able to agree with my colleagues across the table, Mrs Ullrich and Mrs Scanlon.
Before the election, some of us spent months going around speaking to various groups, and I am glad to hear what members are saying about continuing that process. When I was speaking to people in Chest, Heart and Stroke Scotland, they pointed out some of the work that was being done in Scandinavian countries such as Finland, which had had similar problems with coronary heart disease and stroke.
I think that it is a disgrace that, going into the 21st century, the state of someone's health in Scotland is fundamentally a class issue. There may be other factors to consider, such as education and so on, but the links between poverty and ill health are well documented. We must address that.
In my sweep-up list I had down the one word—addiction. People are concerned not only about tobacco and drugs, which we have mentioned already, but about the devastating effect of alcohol abuse. I agree with Hugh's points about sport and young people, but the issue continues right through people's lives. The Justice and Home Affairs Committee will also have an interest in it because involvement in sport can improve people's self-esteem and so has an impact on wider society.
I am concerned that we will try to cover the whole area of health in a very short time. We have to sit down at an early stage to decide on our priorities. Members will notice that the key elements of the proposals in "Partnership for Scotland", which is the basis on which the Executive has laid out its health proposals, are centred on the patient, with increased patient participation and involvement to improve patients' experience of the NHS. That seems likely to be one of the key tests of the organisational performance of the NHS in Scotland and one of our primary functions should be to examine carefully how those aims are being met. If we are simply sloganising about patient participation and it does not mean anything in practice, in four years' time people will be extremely disgruntled with the Parliament.
Sorry, Richard, I want to let Kay come in on that point.
I could not agree more about waiting times. For most people, the time spent waiting from the moment of GP referral to the first appointment with the specialist is possibly the most worrying. We must tackle waiting times; waiting lists have undoubtedly gone down, but evidence suggests that while that has been happening, waiting times have gone up.
That is not true.
That is what the latest evidence suggests. We should ask the Executive for quarterly reports on waiting time progress. We should also ask for the information to be broken down by health board area and by specialty, because we must find out if there are problems in certain specialties.
This is a complex area. If we all agree that we need to examine and establish—in a non-partisan way—the principles by which we want our health service to be judged, we can tell the Executive what we want to hold it to. Kay is quite right: the waiting time for in-patient procedures has dropped, but what does that mean if the patient had to wait to be put on the list in the first place? All sorts of criteria are involved, on which we need, urgently, to establish principles.
I support that, but I want to expand the point. Everyone wants more patients to be treated, but it is not for the Government to decide on priorities; that should be done by clinicians. I do not want waiting lists for minor operations to be slashed while people are having to wait for major operations.
Representatives of the British Medical Association and the Royal College of Nursing are here today and might like to comment on that in a moment.
On a point of clarification—
We are now only 10 minutes from the end of our meeting. Six members want to speak and there are a couple of other matters that we must get through. Unless members feel that they have a burning contribution to make at this point, I ask them to make their comments brief.
On a point of clarification—
We are getting into a specific issue, and it is best if we move on—
No, I need clarification. Was Dorothy-Grace Elder talking about a health service provision or a local authority provision? She needs to be specific.
I was talking about local authority care in the community. I suggest that over the next few weeks, we think about encouraging whistleblowing in the social services and the national health service.
We have whistleblowing already. It is up to people to use it.
It is not used enough. Some awful things are happening and we need to encourage staff to come forward and tell us about those things, without fear for their jobs.
People should be able to do that at the moment, although whether they actually do so might be a different matter.
They do not feel confident.
We are running out of time. I know that Duncan, Malcolm, Irene and Ben—in that order—still want to speak. If we left it at that, they would all have a minute each.
I need less than a minute. First, on how the committee works with reference to obtaining further breakdowns of waiting list times and so on, there is an important point to make about the committee having access to information that is not currently available. Can we have a guarantee that the committee will be able to request the information that it wants and that it will get it?
Absolutely. We will have access to information through our clerks and we have a researcher working in the information centre. However, at my initial meeting with the Executive last week, at which a senior health department official was present, I asked specifically about access to information and was given assurances that there would be a large degree of openness.
I am talking not just about information that is available; much of it is not collated in the way that we would want it to be.
I am all for pushing back those barriers as well, Duncan. For us to do our job properly, we must have access to all the information that we require.
We should decide what we are doing with regard to relationships with other committees. We will relate to all the committees, but most of all, perhaps, to the Social Inclusion, Housing and Voluntary Sector Committee. It might be appropriate, at times, to have a joint sub-committee or joint meetings. My view is that we should be relaxed, for example, if the Social Inclusion, Housing and Voluntary Sector Committee wants to do a study on drugs, or if we want to do a study on the health aspects of housing. We should not feel that we cannot do that.
On that point, I have discussed the idea of having a committee of conveners, in which members could inform others of the direction in which their committees were going. Such a committee would be an early indication of our being able to work across committees to undertake such studies.
Already, from each of us identifying one or two areas of policy in which we are interested, it seems that we have a weighty work load. Does the convener have any thoughts on how to prioritise that work? I am quite clear about my priorities and I should like the issue of tackling inequalities and the link between poverty, class and health to be high on the agenda.
I have heard what everyone has had to say—I will come to Ben in a minute—and have an idea of what members are interested in. It would be helpful if members put their thoughts on priorities in writing. Before the end of the committee, I intended to ask members to delegate authority to me, based on the views that I have heard and on what members put in writing to me, to agree the initial programme and identify some of the first speakers whom we want to brief us. If members are happy for me to do that, I can make progress during the recess.
May I make one additional point? The briefing note that we received mentioned the weighted capitation formula and the fact that it is being reviewed in relation to how funds are distributed to health boards. That formula has been in place since 1977 and I expect that the results of the review, which will be produced in June, will be interesting to the committee. Perhaps we could examine those results soon after the recess.
I understand that the Arbuthnott report might come to the committee so that we can work on it. I assume that that is the report you mean?
Yes.
In the Army, I used to take young men and women from all over Scotland, of all classes and from all social and health backgrounds, and make them fit. We used to say that a fit body meant a fit mind, and vice versa, and was better for people's well-being. I agree with Hugh about the important role of sport and fitness for the young, in terms of prevention.
Health groups have spoken to me about the lack of funding for research. They feel that many of the funds raised on their behalf go into research, when there are pressing practical issues—such as those that Dorothy mentioned—on which they want to use the money. They feel that the Government should play a greater role in research.
When will the committee meet, and could it be at a regular time, for example, on Tuesday afternoons? That would be better for our diaries. Also, we have all come up with different ideas today; I mentioned dental decay. Will the convener clarify whether she will decide on the priorities? If we give her a wish list, for example, a request that the British Dental Association come to address us, who will decide on that?
My understanding is that I will take what members give me and produce proposals. However, I should not like us to lose the possibility of having a few things organised in advance, because I hope that we can hit the ground running when we come back after the recess.
This may seem strange, but I welcome the proposal. Although I have been in the health service for a long time, it would still be useful to have briefings on certain issues. I am just concerned about spoiling our image with the Daily Record if we start meeting during the vacation.
That sounds like a very good reason for doing it.
Reporters might then realise that some of us have packed diaries and are not on holiday, but working in our constituencies; we already have many fixed diary dates. As a result, we need to fix a date as soon as possible.
I appreciate the difficulty in what I am asking committee members to do, but the exercise would be quite useful for us. Afterwards, members could head off to sunnier climes with all sorts of information to read up on over the long recess.
This is supposed to be a family-friendly Parliament. It is not like Westminster, where the holiday period starts in August. For most of us with families, we need July to spend time with our children. Furthermore, because we are so close to July, some of us have already made commitments for the part of that month when we are not on holiday. It would be more realistic to have the briefing day in early August as August is a proper working month for most of us.
I think that all of us will have the same problem and, with respect, I will use my casting vote as convener as my holidays are in August.
If there are problems with getting members together on one day, it might be better to have two half-days so that we do not all miss everything.
We could have a back-up briefing.
If committee members give me an idea of available dates, we can see how difficult it will be to arrange things. If no one can make it, we will not go ahead; if the majority of members can come, we will set up the meeting.
Can we come back and have another discussion on that last point? I have some reservations about the notion of a travelling circus. I do not mind the idea of meeting outwith Edinburgh where it is appropriate and where it will assist our work, but I am also the convener of a committee that might meet weekly. We need to examine how to fit our other commitments into travelling outside Edinburgh. By all means, let us travel elsewhere if it adds value to what we are doing, but I do not want a committee that travels the length and breadth of Scotland just for the sake of it.
I am worried about the public expense of meeting elsewhere. If we have to do that, we should cut out overnight stays and have a very long day somewhere instead. Besides, Glasgow has the worst health problems and it is very easy to get there and back.
This committee has a role not just to talk about health but to go out and see how people on the ground work. Dorothy's point about the public purse is important. If we made the best possible use of a day by rolling a few different items together, that would minimise the effect of time wasted going somewhere and coming back. An important part of our job is not just to talk about health and to listen to one another—which is interesting and valuable up to a point—but to ask people to speak to us and to go out and see how people work in health and community care services and in social work services. That would also be valuable to us.
Meeting closed at 15:23.
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