I welcome Trevor Jones, who is head of the Scottish Executive Health Department and chief executive of NHS Scotland, and Dr Peter Collings, who is director of performance management and finance in the Health Department.
I refer the minister to the choice of portfolio priorities. We have noticed that you have 14 portfolio priorities and 12 national priorities. Can you tell us why there is a difference? Can you list in order of preference the priorities that you have put in the budget?
You will find that there is quite a lot of overlap between the priorities on page 79 and those on page 71. The statement of priorities was given out to NHS boards nearly a year ago and we are considering certain adjustments to it. For example, I am flagging up the idea that public involvement in the coming year ought to be patient-focused, and people who listened to me in the debate on 18 June will know why. The portfolio priorities came a few months later, on the back of the spending review. If members think that there are contradictions between the two sets of priorities, I would welcome their comments, but as far as I can see the two lists are entirely compatible.
There was another part to my question on your priorities in the new list. Do you have any ranking for them at all?
In general, we are trying to narrow the range of priorities. The debate about the number of priorities has manifested itself, particularly south of the border, in a debate about the number of targets. Our approach to those matters is to have a limited number of priorities and a limited number of targets, rather than overburden the service. As is well known, if everything is a priority, nothing is a priority. You tempt me to put them in rank order, but I think that it would be foolish for me to go down that route. It is well known that the areas covered are all important priorities, and we cannot reduce the list to just one or two specific issues.
That is very kind and I appreciate it. Perhaps, as we are now discussing the budget process, you could put some numbers to one or two of those priorities for us. What sum of money have you put towards patient priorities, and how will that be distributed among health boards? Can you give us an indication of whether there are any other administrative costs, either at departmental level or within health boards, for dealing with those new targets and initiatives?
I do not know whether you are referring specifically to the idea of patient focus, but you can correct me if I am wrong. One of the problems with the budget, apart from the fact that the majority of the money in the budget is distributed to boards for them to make decisions about, is that it is not possible discretely to divide all the priorities into specific programme areas. As I said in my previous answer, the priorities run through all the programmes, so we cannot disentangle patient focus and public involvement. There are specific sums of money for parts of that work, but we want it to come through the work of the boards in all those areas.
I think that I understand you correctly. You are saying that you have not deliberately lumped sums of money with themes but have made those themes the basis on which health boards should make decisions about how to use their existing resources.
We are doing a bit of both. I may as well mention the figures that have appeared today showing a reversal of the significant falls in the number of delayed discharges that have taken place in the previous 12 months. I am greatly concerned about that negative development and we will address the matter urgently. Indeed, the Deputy Minister for Health and Community Care met representatives of various boards and local authorities this morning.
How much of the £30 million that you have identified and discussed will be used to equalise payments for care in care homes in the voluntary and private sectors with payments for care in local authority care homes?
I am glad that the member raises that issue. In community care there are many funding streams that work together. The Health and Community Care Committee made a big contribution to the development of the free personal care funding stream, about which we all know. Local authorities are receiving considerable amounts of extra money—£80 million more than they received just two years ago—for care home fees. There is also a third stream of money to deal with delayed discharge by creating extra capacity.
We must do three things simultaneously in community care through local authority budgets: we must pay for free personal care, expand capacity and pay more for places. There is a debate about the third issue, because fees have risen considerably. We know that there is variation, as a recent study highlighted. We are tackling that issue, but significant extra money has already been made available to pay for extra places, as compared with what we were spending two years ago.
I would like to ask about public involvement.
We will address that issue later.
We know that the Executive seeks to achieve a measure of equity in the way in which it allocates funds to NHS boards, through use of the Arbuthnott formula. However, on our patches we have discovered that NHS boards have considerable discretion in how they allocate their budgets in their areas. Do you recognise the danger that the good work that is done at national level, through Arbuthnott, may be lost because of decisions at local level? Will you consider requiring NHS boards to demonstrate that any gains that they make under the Arbuthnott formula reach the most disadvantaged groups?
Trevor Jones should address that issue, because he is responsible for conducting performance reviews with boards. Scoring in the performance assessment framework is published on the web for everyone to see. Part of the answer to Duncan McNeil's question is that we monitor how money is spent on certain objectives and priorities.
I should first point out that, when one thinks about how a health board allocates money, one will see that we use the Arbuthnott formula as a basis for giving the overall sum of money that is available to an NHS board area. The health board then has to fund three levels of services. First, it must fund local community services, and we would expect it to take into account the particular needs of deprived and disadvantaged communities. Secondly, the health board must fund a district general hospital service for the whole of its population. Finally, it also has to fund specialist services for its population. As a result, it would not be appropriate for an NHS board to distribute all its funding down to smaller geographical areas. NHS services are organised in a different way: there is the regional basis, the local or area-wide basis, and the local community basis, all of which need to be treated differently.
Perhaps there is a lack of transparency in that respect. For example, we might need a table that shows any gains or losses in the process. I do not think that my question related to all funding; instead, it related to the Arbuthnott aspect of that funding, which in my opinion is not large enough. How do we reach the stage where national priorities are delivered to deprived communities that have not benefited from the formula or where sub-programmes can benefit from it? Is it not time to instruct that those priorities be followed through to ensure that a community's particular need is not sacrificed for a pressing specialist need?
Trevor Jones might want to come back on that question. I should point out that all the information about the performance assessment framework is on the website called "Scotland's health on the web" but, if members prefer, we could certainly send it to the committee in hard copy. At least I think that we can do that—there is quite a lot of information. The first section of the framework focuses on health improvement and reducing inequality, which means that we are examining those indicators. Indeed, as I said in the debate a couple of weeks ago, we are seeking to develop more sophisticated indicators of health inequalities.
But not below board level.
The indicators will show whether boards are managing to reduce health inequalities, which I presume is the objective of your question.
I am testing you on your objective, minister.
That is the objective.
As the Scottish Executive Health Department, you allocate a certain amount of money for deprived areas and to deal with health inequalities. However, when you hand the money over to the health boards, you do not expect them to follow that course.
I have made two points in that respect. First, we are measuring boards' effectiveness in reducing health inequalities, which is the objective of that part of the Arbuthnott formula. My second point goes back to the previous time when I was before the committee. Money over and above that which is allocated through the Arbuthnott formula is also distributed. Indeed, one of the features of the new general medical services contract is that the amount of money that is given to a practice in a particular area takes into account health inequalities and deprivation.
I come at this from a different angle from that taken by Duncan McNeil. The Arbuthnott formula does not take into account demand for NHS services. For example, the Grampian NHS Board area that I represent in the north-east survives on nine tenths of the income that it would have if the funds were worked out on purely a per-head-of-population basis. I am not arguing against the Arbuthnott formula, but perhaps it should take demand into account. When is the formula due for re-examination, because it is not satisfactory as it stands?
It will be up for re-examination in the next 18 months. We have always said that that will happen. A range of concerns have been raised in your area and in the island board areas, but equally the urban authorities, most notably in Glasgow, have particular issues with regard to what I said in my previous answer. However, the issues will be considered within that time scale.
Is the chairman of Greater Glasgow NHS Board still the chairman of the Arbuthnott formula committee that decides on allocations?
He is still involved in making recommendations.
The next review is an issue that we will have to pick up when the current work programme is completed. Over the next 12 months, we will need to think about the composition of the committee that will consider the resource allocation formula.
My point is about appropriateness.
We note the point that you make.
The minister touched on what I was going to emphasise about the Arbuthnott report. Unmet need is one of the most important things that the report flagged up and I am delighted that the department is doing more work on it.
There are two parts to my answer. There is obviously a research agenda, and a lot of good work has been done, particularly in Glasgow. I remember when Dr Watt gave evidence about that to the Health and Community Care Committee in 1999. I would like to involve a number of people in discussions. It would be invidious to name the individuals involved, because there are quite a lot of them, but they will certainly help with the evidence base. I announced in the health improvement debate that we want to support financially the Glasgow centre for population health, because there is academic expertise in Glasgow on these issues.
What is the time scale for that work?
We want to progress things quickly, but we have some further work to do in order to establish in detail how the pilots might best be done. We are involved in that work at the moment.
Could I press you a little on the time scale?
We want to get the matter sorted out for the beginning of the next financial year.
Duncan McNeil asked whether there were any tables or figures showing where money goes once it is allocated to board areas. I am a bit concerned about that. I think you said that, if there was evidence of health inequalities being addressed, that would be the outcome that you would expect for the extra money—or for the relevant part of the formula allocation. Outcomes are difficult to measure sometimes. If the figures or data that Duncan McNeil referred to were available, it would be much easier to measure the input and to ensure—using the indicators on which the Arbuthnott formula is based—that specific groups are receiving the money.
As your own remarks indicate, the matter is complicated. A lot of the actions to address health inequalities will indeed come from the health improvement agenda. That strand relates to other interesting controversies. Part of the Executive's argument is that we need to target resources in order to achieve the maximum effect from the health improvement strategy. Many people in the Parliament criticise us for that, and say that all provision should be universal. It could be argued that we are quite strong on targeting resources for health improvement, which includes the broad health improvement strategies such as the central heating programme.
I think that that covers the point, minister.
There is more equality when it comes to acute services, particularly in relation to someone who has a certain condition or who needs some sort of operation. The inequalities arise more often in primary care.
That is being reflected—although perhaps not to the extent that you might wish—in the proposed new formula, which will avoid the problems that you are describing. Mike Rumbles made a point about that earlier.
Inequalities affect the hospital sector as well as primary care, if people from deprived communities present with diseases at a later stage.
That is the point that I was trying to make.
We must have an inequalities agenda for both the acute sector and the primary care sector.
The point that I was trying to make is that once people reach the acute sector there is inequality. The primary care sector must address inequalities so that people do not present at later stages. I would have thought that it would be easy to measure where that money was going to.
The minister talked about a review of the Arbuthnott formula. Has Arbuthnott worked in that it has produced the intended outcomes as opposed to outputs? What work has been done to measure that? Can the minister give the committee evidence that the outcomes that were projected when Arbuthnott was introduced have been met?
Arbuthnott took more factors into account than the previous formula did. The Arbuthnott formula is applied at Scottish level as distinct from NHS-board level. We are interested in the latter level, but Arbuthnott is interested in distributing the money fairly at a Scottish level. That approach is better than the previous one and is the best that we have had, but the Arbuthnott formula is not perfect and that is why it must be reviewed continually to ensure that board areas get their fair share of the Scottish cake. There is also a series of processes, such as our own performance assessment, that can improve. That involves a separate process, which we must undertake on the back of the Arbuthnott formula or a revised Arbuthnott formula.
Perhaps I am still hung up from my days on the Finance Committee, but fellow north-east MSPs and I might dispute whether in our localities you are achieving on the ground what you call fairness. However, you have your officials with you today, so I will ask what measurements there are in relation to the budget to demonstrate that the Arbuthnott policy is effective and that you are getting the outcomes that were projected when you chose to implement the policy.
Arbuthnott is not a policy. We have a range of policies and priorities, as you pointed out, and we do performance assessment in relation to those. Arbuthnott is not a policy; it is a way of distributing the money in the fairest possible manner.
All right—I will rephrase the question. Do you think that the formula is working in that it is delivering the policies that you think should be delivered through it? How do you measure that?
I suppose that all that we can do is to compare Arbuthnott with what went before. I think that Arbuthnott is an improvement, but I do not think that it is perfect. Obviously, Arbuthnott causes much controversy, not least in Mr Davidson's constituency area. However, even people in that area who think that Arbuthnott is not fair would agree that Glasgow needs more per head of population than Grampian. People might think that Glasgow does not need as much more as it gets, but I am sure that everybody in Scotland would accept that Glasgow needs more per head of population because of the concentrations of deprivation there. In that sense, I definitely think that Arbuthnott is an improvement.
I presume that you will build into the rurality aspect the new chores for which health boards in rural and remote areas will have to become accountable when the Primary Medical Services (Scotland) Bill gets through in some form or other.
Yes, but as you will know from your other recent work, the reality is that that money will be distributed by a different formula. As we know, the money that will go into the new GMS contract will increase by a third what has been available before. We went over all that at a previous meeting. Extra money is going into the contract. I understand people's concerns about out-of-hours provision, but there are funding streams to enable that to be delivered differently.
I want to return to transparency at NHS board level, which you have touched on in answer to questions. There is a budget in which 80 per cent of the detail covers 20 per cent of the spending. Therefore, 80 per cent of the spending is not detailed in the budget. The committee has raised that issue time and again. Although it could be argued that prospective planning information is available through the local health plans, that information is not collated to give us a national picture. Additionally, we often get sight of those plans only halfway through the year, so they are not prospective at all. What progress have you made in addressing that issue and what further detail can we expect in the budget document for next year?
The issue is what information is in the budget document and what information is available. I am sorry that what I sent you was sent later than it might have been, but the work is not—
On that issue, I am grateful for what you sent. Unfortunately, it arrived in hard copy on the desks of MSPs—some of whom had to travel quite a distance—at lunch time. If such information is to be of use to the committee in dealing with the budget next year, it should be sent to the committee early, before stage 1.
I apologise for that. As I have said, the information has not been updated completely, which is what we were trying to do. When I realised that that was not going to be possible, I thought that it would be better to send an incomplete document rather than nothing at all. I apologise for the fact that the document is not complete and for the fact that it was not sent to you earlier.
NHS boards are separate statutory organisations, and it is for them to make decisions about local spending priorities. That information is in the public domain. It is contained in the boards' annual accounts and the financial reports that they take to their public NHS board meetings throughout the financial year. At those meetings, decisions are made about spending. All the local NHS boards' spending decisions are in the public domain; however, those decisions remain for the local board to make.
Would you not agree that a lot of that information tends to be retrospective rather than prospective? It has been my experience that, although we can know the detail of the spending once it has been spent, it is difficult to get a national picture of prospective spending—in fact, we cannot get that. Perhaps the Health Department could collate the information to give us a nationwide picture of the prospective spend. That would be extremely helpful.
Trevor Jones may know about the time scales. The Parliament starts its budget process early. We started a bit later than usual this year, for obvious reasons, but we tend to announce our budgets early. I am not sure when NHS boards would normally have such information available.
The boards' budget process starts around November, in advance of their knowing what their firm cash allocations will be. By March or April, they begin to finalise their budgets. A number of boards will forecast a deficit for the year, as their spending intention is above the amount of cash that is available. Through April and May, they will bring their budgets into line with the resources that they have got. By June, NHS boards should have a clear financial plan for the coming year. All of that information is available locally, and we receive boards' plans throughout the summer. Around this time of year, we start to get a feel for the detail of individual NHS board spending plans.
So, it should be possible for you to collate for us a nationwide prospective spending plan.
We are a year out of synch. You are talking about the NHS boards' plans for this year, whereas we are considering our plans for next year. Is that right?
That is right.
Sorry. So you are.
It depends on which year you are talking about.
So you are saying that that proposal would not be possible because of the delay.
Every local health plan contains a five-year forecast of expenditure. We could work with the committee on whether we could base something useful for the committee on those five-year plans, which are in the public domain and are published locally. We could work with the committee on bringing the plans together to provide a national perspective.
I am the new girl here, and I thought that it would be nice to see where we have come from, where we are and where we are going, and to work out a cost-benefit analysis. I naively thought that we would have something like spreadsheets that I would have to learn and understand. In fact, we receive policy documents, more or less. If we did not have the advice from our adviser, collating all the information would be difficult. I support Shona Robison's request. The information for which she asked would make the committee's work more meaningful. We should have more information, on time.
I understand your point. There are the two issues about what is expected in the budget, but that does not need to be the end of the matter. The issue about boards arises every year. Some of the issues are frustrating for me, too. If we can make more of the information about board spend available to the committee, I know that that will make the committee's job more meaningful, because that involves the bulk of the budget. I imagine that such considerations apply to other matters—the obvious example is local government, which has an impact on many of our priorities, too.
The Health Department sets targets and is responsible for monitoring them. We are talking about transparency, so could we see at an early stage of future budget processes the results of your monitoring of prior targets?
Trevor Jones can go into detail on that. That information is available through performance assessment.
We monitor all the published targets and there is no reason why we should not discuss with the committee how to present that information. The performance assessment framework, which provides the overall assessment of an organisation's performance, is published on the website called "Scotland's health on the web", so those data are available. However, it might be useful if we took the committee through that.
To be fair, I am looking for a simpler, more user-friendly document for the committee, because the committee is working with only a tiny window of opportunity on the budget, unlike the Finance Committee. It would help to have that information up-front.
In principle, that is a good suggestion. Part of the problem is that a welter of information is available. We need to home in on what is most useful to the committee and how we can provide it.
I think that Shona Robison and others were asking for the prospective local NHS board spend and a comparator across the board areas, so that we can descend a level from the bulk amount that boards receive. When would you have the data to make a spreadsheet on that available to the committee?
The last two questions have addressed two issues: the prospective five-year financial plans and—
I was thinking of just the information for 2005-06.
The problem that I flagged up is that the detail is available for this year, but I understand from what Trevor Jones said that the boards are not as far ahead as we are in the Parliament. Therefore, we could collate detailed information for this financial year but, apart from the five-year plans, I understand that detailed plans have not been made for the next financial year. Is that correct?
That is right. The five-year financial plan shows the overall financial status of the NHS. That would not be shown in levels of detail for individual boards. I formed the impression that the committee was looking for that. We can construct something around that from the published data.
We will think that over.
On the second point, we can try to provide information on targets.
The initial question was on transparency. We have highlighted the need for transparency at committee level but it is surely equally important that we get transparency at board level.
I would certainly support more transparency all round. It would be entirely helpful to our public involvement agenda if there was more information on, and understanding of, what the money is spent on in each NHS board area. For example, the drugs budget has been in the newspapers this morning. I suppose that it is just a distinctive feature of NHS board budgets that, of the significant increases that boards have received, somewhere over 1.5 per cent will go into the drugs budget, which rises year on year. That is a particular feature of the health budget. The more transparency that there is about all those things, the better.
My observation is that the priorities of the trust or board or whatever are dealt with by the managers and specialists. I do not see how the community influences the debate in any real sense at the moment. If people knew how much money the health authority had for new developments and plans, they could be included in the debate. However, at this point, the public are not much involved at all, because the different sums of money are not even defined.
There is certainly a wider public involvement agenda. I do not disagree with Duncan McNeil that discussion about resources should be part of that, but the other fairly obvious thing to say about the health budget is that about 70 per cent of a board's budget goes on staffing costs. The other pressure on the system comes from pay increases and the simultaneous expansion of the work force. When the extra staff and the extra pay are added together, they are obviously the most significant feature of local NHS board budgets. However, I do not disagree with what Duncan McNeil has said. He might ask what I am going to do about that. We certainly want to make progress on improving information and transparency about board budgets at local level.
How will you do that?
We have already discussed what information could be made available to the committee, but the reality is that the issue is not really about bringing things out of the shadows. Much of the information is already available in board papers, on websites or in documents. The issue is more about how we make that information more accessible to people. That is probably the territory that we need to explore.
That is right. Most NHS boards will have very open discussions about their spending priorities. I guess that what we need is consistency across the service in how that works. We need to build on best practice to involve communities in the budget process.
Have members any other questions on that issue?
We keep on talking about public involvement; it comes through in everything that we have discussed. However, the public out there are, I suppose, a little bit jaundiced every time they hear that, because they doubt that it will happen.
The first—
Before I let the minister answer those questions, I also want to ask whether there is a way of finding out from the NHS accounts how much all the outside consultancies cost. How much does the paperwork that is handed out cost?
I think that you have asked about 30 questions, Jean.
I am talking about the material that people are bombarded with. Perhaps the minister could let me know from the accounts what those costs are.
Trevor Jones might want to pick up on the particular issue of consultancy. A lot of more general issues were raised. The first thing to say about public involvement is that it is not nearly good enough. The second thing to say is that it is better than it used to be. However, that is not ground for complacency or self-congratulation. I am aware that I am repeating myself, but the third thing to say is that it is helpful to distinguish between the different parts of the agenda.
Was Dr Turner asking about the use of consultants for service change?
I was talking about the outside consultants who are bought in.
One of the difficulties is the need to define who is a consultant in those circumstances. A quantity surveyor or architect who is employed in relation to a major capital scheme would be a consultant. Another example would be commissioning a company such as MORI or a voluntary organisation to conduct a survey of the public's view independent of the health board. Although we do not collect centrally the cost of all such bodies that are used by NHS boards, we can say that the boards would use consultants only for functions for which the skills are not available in-house and that the competitiveness of the consultants would be tested by seeking quotations and tenders.
I am surprised that you do not collect figures on the amount that is spent on consultants.
We have examined the problem of defining what is meant by a consultant in relation to various parts of the public sector. A difficulty relates to the fact that, these days, most of the firms that are involved in this general business area provide a wide range of services, which means that we can no longer tell by a firm's name what sort of work it is being used to do. If a board were to embark on a major piece of work, we would expect that such information would be evidenced in the papers authorising that piece of work. We have considered collecting the information centrally, but we have failed to come up with a consistent way of doing so.
I think that it might add up to quite a bit of money if health boards throughout Scotland are using such consultants regularly. I would have thought that the expertise would in the past have been available within boards, but it seems that there has to be some outside expertise—perhaps a couple of people to assist people within the board who have some expertise—when a board is examining acute admissions, for example. To me, anybody who is not on the payroll of the board would be an outside consultant.
When I joined the health service, all health boards employed quantity surveyors and architects and had large estates departments. Over time, as it was demonstrated to be more cost effective for the NHS not to employ such people but to use professional staff from outside the board for particular functions, the NHS moved those services out into the private sector. Using such professionals only when we needed them for particularly complex work provided better value.
Are assessments still being made to determine whether that system provides value for money? That process should be on-going: it should not be accepted that the arrangement still provides value for money just because it did at one time. The public feel that far too many outside consultancy firms are used. If you are unable to produce figures to refute that belief or to prove that it is cost-effective to use consultants, the public will continue to believe that.
I suggest that we have exhausted that seam of questioning, but it might be worth examining that issue at another time, because it is relevant.
I come at the situation from a slightly different angle—I believe that people can be expected to make informed choices only if they are given as much information as they need beforehand. We have spent a lot of money on consulting people and although I accept that the process is better than it was before, it is by no means perfect. The difficulty is whether such consultation represents good use of money when, at the end of a consultation period, decisions are made to implement initial proposals that have not changed substantially, if they have changed at all.
It is crucial that we evaluate the feedback and report on it, which has not always happened in the past. Perhaps the most important thing is to involve people much earlier. It does not have to be the case that one goes out to public consultation on a matter with a particular proposal in mind—sometimes it is best to discuss the dilemmas, problems and choices much earlier and to get the public's input before a definite proposal is formulated. That is part of the way forward.
We would be interested to hear some firm proposals about how we will support community involvement and lay participation in the process. We welcome what the minister says about the experience of patients and their involvement, but much of the controversy arises from a point of crisis in the process of change. Recent experience shows that there is no real weighting in the case of community interest versus specialist interests. The specialist interests are there at the beginning of the process, they decide the framework, they decide the limitations and they decide the boundaries. Everyone else is then expected to conform to the process. The current experience is that the public tries to influence a process that has already been decided and which the specialists defend. I would like to hear some proposals today that will describe how we will support community interests over specialist interests.
That is one pattern and I am sure that it has happened over time, but there are other patterns. One of the things that we must do is to learn from best practice—I suppose that we try to disseminate good practice in many areas.
I will halt you there—I suspect that the problem is that we have not really heard specific proposals about engaging the public in consultation. I will give the specific example of the Primary Medical Services (Scotland) Bill, which we have been dealing with at stage 1. We were trying to work out how much patient consultation had been involved in that bill—perhaps you will be able to tell us.
The Primary Medical Services (Scotland) Bill is the exception that proves the rule, because you know as well as I do that that bill is unlike any other bill that has been before the Scottish Parliament, in the sense that it seeks to enact an agreement that has been negotiated already. That is unprecedented.
We look forward to receiving the final guidance. The only thing that I would say on the Primary Medical Services (Scotland) Bill is that, although it represents the implementation of a contract, it is legislation that will impact on people's lives through their GP services. I am trying to read what you said, which was—I think—that there was no consultation on the bill, because it is the exception that proves the rule. I presume that that means that there was no public consultation.
When I gave evidence to the committee, I said that there would be extensive consultation on the implementation of the contract. It is hard to see how there could be public consultation on something that had already been agreed in negotiation across the table. The consultation will be on implementation of the contract, but the agreement on that was negotiated at UK level and a bill was produced to deal with the contract's legislative consequences. That is not the usual process for the work of the Parliament.
If Duncan McNeil's question is short, I will let him in before Helen Eadie and David Davidson.
The question is, if you believe in public consultation, how do you make it happen, in particular at challenging times of change? How do you ensure that local clinicians and senior consultants participate in the process? That does not seem to happen; it has failed miserably.
Everything that I have said today agrees with what you just said. I pointed out that the Primary Medical Services (Scotland) Bill is slightly different from most of the other issues that we are discussing. I agree with you—every word that I have said today about the subject shows that I am dissatisfied with what has happened in the past. Things are getting a bit better but we have much further to go.
I ask you to factor in to future budget planning closing the loop in public consultation. I have nipped your head about that in relation to public consultations that have taken place in my area. For example, the last time Fife NHS Board met Fife MSPs, I made the point that it is all well and good to consult people, but not going back to them to explain what decisions have been taken, and why, angers them even more and builds on the resentment that other members have described. People feel that no weight is given to their views, so it is vital that we build feedback into next year's plans.
I assure you that feedback will be a feature of the final guidance. Reporting back is essential, although it is not the only thing that is essential. I have been emphasising that people must be involved at the earliest possible stage because past perception—and reality—was that proposals were made, after which there was formal consultation that did not change anything. We are trying to get away from that and the best way to do that is to ensure that people's views are taken as early as possible so that they can be fed into the development of options.
You mentioned the open-space event that took place in Perth on behalf of Tayside NHS Board. There are some very serious issues there about, for example, how the board will roll out the mental health services that are required under the new legislation. We seek assurances from you that you will not only hold such innovative events—I heartily approve of them—but that there will thereafter be only a short time before a report is issued that lists the options that are available to the health board, what the health board's decisions are, and why it did not accept some options but went with others. People who attended the open-space event are already asking when they will hear what the input was, what the options are and what will be delivered. I focused on mental health issues, but I am not saying that Tayside NHS Board will not roll out the services.
That repeated in more detail what Helen Eadie said. I agreed with her and I agree with you. However, we should not assume that what David Davidson suggests will not happen with the open-space event. We should pay tribute to Tayside NHS Board; it was that board's event and it should get the credit for it. I am sure that the board will be mindful of the points that David Davidson raised. Indeed, I shall draw the board's attention to those points.
I have already made my points, minister. It is your position that we are trying to draw out.
I obviously applaud the good practice that I have seen in Tayside, and I agree entirely that what David Davidson described should happen. The boards obviously have a lot of responsibility for such matters, so it is not right for me to become involved in the substantive issues at an early stage if I have to make a decision later. However, I am saying quite clearly that the centre is more determined to be engaged with the process issues. In fact, we are looking far more closely at the procedures that are adopted, because it is self-evident that there is no point in our coming up with all sorts of good proposals and guidance if they are not followed. We will do that, of course, but I do not have reason to believe that Tayside is failing at the moment in that regard.
Before we move on, I have been passed a note by the clerk asking whether members would like a short intermission—as they used to say in the cinema—or whether you wish to continue. I am in your hands.
Let us press on.
Very well. I did not ask the minister, I am afraid, but whether we break or not is in the committee's hands, not his.
The main reference point is the table on page 7 of the draft budget. We do not want any self-congratulation from the health department, but it should be observed that EYF is very low compared with previous years. It stands to reason, therefore, that the health department's end-year flexibility—or underspend, as it is sometimes called—is extremely small. We have the largest budget, but we also have one of the smallest underspends, which I think is evidence of good management of our finances in the previous financial year. The corollary of that is that there is not a lot of money to play with. In fact, all that money is sitting in boards' budgets and will be spent by boards—
That was not what the question was about. The question was: if you have that money and decide to allocate it to certain projects—which is very worthy—how do you know that you have spent it in the right place? How do you measure the cancer programme's work or the heart programme's work, so that next time round the committee can either agree with or challenge your allocations?
The point that I am making is that we are not allocating any end-year flexibility. All £24 million—an incredibly low figure compared with the figures from two years ago—is not being allocated. It is in the boards' money and will stay there and be spent there. In a sense, end-year flexibility is not much of an issue in health, because all that it means is that the money is spent by boards in April or May rather than in February or March. The figure of £24 million is, as far as I know, the lowest ever. It is much lower than it used to be. That money stays with the boards. The point that I am making is that there is no end-year flexibility money to make decisions about at the centre.
Is that £24 million in the base budgets for next year?
It is carried over in the boards' budgets.
You allocate funding to specific projects, which is very commendable, but we cannot scrutinise the end-year flexibility that has simply been allocated to cancer or to some other area. How can the committee, and you, measure whether that money has had a certain outcome, compared with using it elsewhere? With a limited budget, it might have been better to put the money somewhere else, but how do we track it?
Cancer is a good example. Not all the information, apart from the headline amount, is in the budget document, but there are monitoring reports every six months and every single penny of the extra £25 million that goes into cancer every year can be tracked. That is obviously not the whole of the cancer budget, but all of the extra cancer strategy funding of £25 million is reported on in great detail in six-monthly monitoring reports, so it can all be tracked on a continuing basis.
The question is not about the allocation, minister. Perhaps I am not explaining this very well. The question is about whether money from a limited budget has produced a better outcome than would have been the case had you put the money somewhere else. How can we measure that?
That can be measured in two ways. We keep an eye on cancer statistics, but no one would claim that investment in the past year has changed those statistics immediately, although the bad cancer figures are obviously not as bad as they were, so we are making progress. The key point is that we can see what the money is being spent on. A lot has been spent on staff. You may ask how I can evaluate the contribution of one extra nurse specialist or one extra consultant, but most people would agree that such members of staff are beneficial for cancer patients. The amount spent on staff can be quantified; indeed, I quantified some of it during a recent debate on cancer. A lot has been spent on equipment. Also, you can track other budgets such as—
I am sorry, minister, but this is not about what the money is spent on but about measuring the outcomes. If you are saying that those outcomes are difficult to measure, how do you prioritise?
We can measure some of the outcomes. I have referred to mortality figures, which can be tracked over time, but we can also track waiting times for cancer patients. It is therefore possible to demonstrate that waiting times for radiotherapy have come down significantly through investment in new linear accelerators. Waiting times are still too long but, at the Beatson oncology clinic, for example, times are a whole lot shorter than they were two or three years ago. We can therefore track waiting times and, over a longer time, we can track mortality figures.
No one else seems to want to ask a question on this issue so I will make two final points. First, can your department tell us how much has been allocated to specific projects in a financial year and what were the outcomes?
Obviously, we want to evaluate programmes, and we do so. No doubt, we could do that more extensively—although people might in that case ask us how much time we intended to spend on evaluation as opposed to other things. However, in principle, I do not disagree with the convener's points. We do a lot of evaluation already.
I want to ask a technical question about end-year flexibility. The £24 million of EYF this year was already allocated to boards, so it is still with them. Last year, EYF was £49 million. Was that money allocated to boards or was it moved from other budgets? If so, where was it targeted? If health is such a big priority for the Executive, why is the amount of EYF this year less than half the amount last year? I do not know whether you will be able to answer those questions.
Wait a minute. Trevor Jones can deal with your questions about the £49 million, but I cannot believe what I am hearing—for years we have been criticised for having big underspends. Health is a big priority for us and the reduction in EYF shows that we have managed health spending well this year.
That depends on your answer to my first question. Was money moved from other departments to create the £49 million figure last year or did it all come from underspend in the Health Department?
None of the underspending that has occurred in health has moved to other departments or vice versa. Health underspend remains in the Health Department. This year the underspend is smaller because we are committing resources faster and closer to the limit. Health has a budget of approximately £7 billion and an underspend of £24 million. That is as close as one can get to breaking even when managing a budget. We cannot overspend—we must live within our resources. The underspend is one third of 1 per cent of the health budget. I wish that I could get so close to breaking even when forecasting spend from my monthly salary. Spending is getting tighter because there are financial pressures on the NHS and health boards, so underspends are falling.
Given that last year EYF was not moved to health from other budgets, I am happy with the size of this year's underspend. Was the sum of £49 million left with boards or was it targeted at other areas?
I do not remember precisely, but we can supply the committee with that information. The vast majority of the money was left with boards. That is committed expenditure—it is not sitting unspent. The cash is committed on issues such as staff costs and will be absorbed by 1 April.
Will it be spent on dealing with issues such as unfilled vacancies?
Yes. If a board appointed a member of staff on 1 December, in that financial year it would spend only one third of the funding for the post, but the following year it would need 12 months' expenditure. For that reason, there would be underspending in the first year.
From March to April there is also an element of slippage in spend on capital. Money needs to be carried forward to deal with that.
Are you content, Kate?
Yes.
I am particularly interested in the relationship between the budget and the partnership agreement. In his foreword to the draft budget document, the Minister for Finance and Public Services says that the document
There is one self-evident point to make by way of preamble. The draft budget came out before Andy Kerr made his statement in Parliament only two weeks ago so—and I imagine that this is true for all departments—the budget documents could not reflect the money that was announced in that statement. Such a late announcement could not be factored into the document.
Secondly, we cannot disentangle every commitment and have a separate budget round it. It is like a previous point that I made: we cannot always disaggregate a budget. The first commitment in the partnership agreement is to do with waiting times for in-patients, and it then goes on to deal with out-patients. Although there are budgets that are relevant to that, such as those for the Golden Jubilee national hospital and the national waiting times unit, I cannot point to a specific budget that will address that issue.
I am sure that you will recall as well as I can that in the negotiations between the two governing parties every item had a price tag, so I am surprised that we do not see that in the documentation. It is a simple question. I know that the civil servants produced that information in the negotiations and I expected that, in this era of openness and transparency, it would be reflected in the budget documents, but it is not, and I wonder why not.
The other point to make is that, as Andy Kerr pointed out in his statement, we still have some announcements to make in relation to these issues. Tom McCabe will make one tomorrow about digital hearing aids. A related point is that there are existing budgets for many of the matters to which you refer, so the issue may be how we will supplement them. Indeed, that is what Tom McCabe will say something about tomorrow in relation to digital hearing aids.
I raise the issue because it would be in everyone's interest to have transparency. In fact, it is in the interest of the Executive to say, "These are our commitments, this is our funding and this is what we are doing." The Executive should be more open and transparent.
Okay. Further announcements will be made, but perhaps we need to produce a specific response to your point when all the announcements have been made, so that it is transparent. However, I add the caveat that it is quite difficult to disaggregate specific budgets. I would be interested to see the figures to which you referred, but it is difficult to have a specific budget for some of the commitments. I will stick with my example of waiting.
I return to the aims and objectives of the health and community care draft budget. Two or three questions leap out of that. Target 10 in the draft budget is to
New people are coming into the NHS through training, but an important issue now is returners. We have made great progress with our return-to-practice programmes over the past year in particular. Several hundred people are coming back through that route. The aggregation of the new people and the returners makes up the figure of 3,000. This year, we are significantly increasing the numbers who are starting to train as nurses, by an extra 525. Improvements are showing up in the numbers in initial training and in retention work, with its big agendas of continuing professional development and return to practice.
So we are talking about £112 million or thereabouts for nurse training, an element of which is obviously taken up with college or university fees, support and so on. Is there a separate figure in the budget for attracting people back to the profession?
The difference in that case is that nurse education and training are paid for through the Health Department.
I understand that, but does the budget contain a separate figure for attracting returners into the profession and giving them CPD?
The return-to-practice initiative is part of the "Facing the Future" budget, which amounts to £5 million and forms part of one of the longer budget lines. Perhaps Peter Collings or Trevor Jones will be able to tell me which line it is. We were asked to give level 3 lines in this budget document; obviously, level 4 lines would give greater detail and would include some recruitment and retention work in nursing. Is it included in the "nurse education and training" line?
Yes.
Thank you.
This is a source of continuing difficulty because the vast bulk of community care money is not contained in the health chapter of the budget. Instead, it is buried in the local government figures, which are sometimes even more difficult to disentangle than the health figures. As a result, the community care spending in the health chapter is a marginal part of the overall community care budget. Certainly, the personal care money will go through—
That is why I recommended in 1999 that the two budgets be merged. It would have allowed us to find out what was going on.
That is a policy point for which you would have to advance other arguments. However, I acknowledge that there is a debate to be had on that matter.
Some figures have not yet been announced for certain items right across the budget. The small amount of EYF money that has been allocated to health boards is not included in the budget. You are not saying that there will be huge amounts of new money, but there still seems to be very little movement in a number of areas in the printed draft budget, with increases that are less than the rate of inflation. Are you intending to postpone some of the activities set out in your action plan until another year and then make announcements in perhaps a year's time or will you dip into the substantial new reserve money? Perhaps Dr Collings is better placed to answer that question.
Obviously the situation varies from line to line. You can ask about any particular budget line you want, but you should bear it in mind that, just because the budget is increasing, it does not necessarily follow that every line has to increase by the same amount or, indeed, increase at all. Part of setting priorities is to ensure that the correct lines are increasing. That said, if lines have already been substantially increased, the key might be to keep them at a particular level. That was the significance of the announcement that I made in the cancer debate. We have already given funding a big boost; the important thing now is to ensure that the money remains ring fenced and spent on cancer services. As I said, the situation differs from line to line.
I want to clarify this point for the Official Report, because we will obviously want to go back and look at what has been said. You said just now that you saw no need for a line to increase, even though a new priority had been set. Does that mean that priorities within an existing budget stream have been readjusted?
My point was that I do not see why every single line should increase by the same amount or by any amount. It might be quite reasonable that some lines are the same. If we want to target the increase into a particular area—
I do not argue with that principle.
The delayed discharge line has increased by £10 million this year, which is necessary. Today's figures are very disappointing. The extra £10 million that is going in will help, although there are other issues that we need to address. Delayed discharge is one line that is increasing, but we cannot increase every line.
I do not dispute what you are saying. From an accountancy or management point of view, it is wise to make such statements, as they do not raise expectations. I understand from what you are conveying to the committee that, although you have new priorities, there might not be new money to back them and hard choices will therefore have to be made. I think that that is your message.
Hard choices always have to be made in every budget, and certainly in the health budget. I have been saying that in relation to hepatitis C over the past few days.
That was a political answer. I have a question about pages 72 and 73 of the draft budget. The heading "Closing the opportunity gap" appears on page 72 and, opposite it, on page 73, there is the heading "Equality". I note that £49 million is to go to vulnerable groups. That is less than 0.5 per cent of the health budget. Nevertheless, it is there. Helpfully, the paragraphs under the "Equality" heading specify funding. There is a difference between that and the text that comes under the "Closing the opportunity gap" heading. Could you provide us with more specification in this area in next year's budget documents? For example, the document mentions
There are two issues there, relating to outputs and inputs. Some of the output issues will be dealt with under the information on the performance assessment framework. On inputs, we can look into what you suggest. Some of the health improvement money is obviously targeted towards closing the opportunity gap, so I accept the point that it would improve that section of the document if we had some figures there.
That would be very helpful. That was a tiny hit, so we will move on.
We welcome the NHS Quality Improvement Scotland initiative, which aims to bring an end to postcode prescribing. The question is whether that will be enough. I am sure that there are examples of areas where there is still postcode prescribing, despite the input of the Health Technology Board for Scotland and the Scottish medicines consortium.
A lot of work is going on in that area, but I repeat that, even with the existing situation, which is not ideal, the amount of the increase in funding for NHS boards that is going into prescribing is more than 1.5 per cent. If predictions are right, that is set to rise as new drugs come on stream. The rising costs of the drug budget form a significant element as regards health finances and the difficult choices to be made.
The important issue is how we develop the Scottish medicines consortium. Should its recommendations be compulsory and mandatory throughout Scotland? How do we ensure that the SMC is linked effectively into the management of NHS boards? The membership of the SMC includes a chief executive and a finance director. How do we get a common implementation plan to introduce new drugs throughout Scotland, so that there is no inequality and access to drugs does not depend on where people live?
Will that culminate in data being available to the committee showing whether there is a fair and consistent implementation of advice throughout Scotland?
I guess that if we move in the direction that I am suggesting in relation to the SMC, such information may be available to the committee in the consortium's reviews of new drugs and how those drugs should be introduced throughout Scotland.
It is a matter not only of how they should be introduced but of whether they are introduced. The committee would like to have that information. When will it be available?
We will have to think about how to do that.
Yes, but will you make a commitment to go away and come back to us on the matter?
Yes.
The partnership agreement states:
We cannot interfere with clinical judgment. However, it would not be allowable for the prescription of such a drug to be explicitly forbidden and if it were not prescribed at all, people might ask questions. We have to watch that we do not interfere with clinical judgment, but there is no reason why the drug should not be prescribed at all in a board area.
I do not think that Mr Jones will be terribly surprised at what I am going to ask. In the Health Department's review of the costs on the drugs budget, not only inflation but prescribing trends are taken into account. I presume that the department will also consider the cluster occurrence of different conditions that require expensive interventions. How will that be built into the Arbuthnott formula? It has nothing to do with the formula as it exists. An area such as Grampian could have a large number of people requiring three or four very expensive treatments, whereas—for the sake of argument—Forth Valley NHS Board might not face the same costs. Nevertheless, the Arbuthnott formula is being used to distribute the money within the drug budget. Is there going to be some clear agreement?
You will recall that our policy is to take away the barriers between primary and secondary care. By 1 April next year, the whole of Scotland will operate a single NHS system, without the barriers between acute trusts and primary care trusts. We will expect NHS boards to manage the total funding that they receive and not to have the pressure that currently exists between the separate statutory bodies. That policy, again, takes us into thinking about the total patient experience and thinking much more about how an individual patient travels from primary care through the secondary care sector back into primary care and perhaps into social work care—that is the concept of managed clinical networks. The distinction between the acute and primary care sectors is becoming less and less important.
Does that mean that there could be an increasing role for managed clinical networks?
Yes.
Many of them will represent more than one NHS board area. Will that be a way of managing the budget?
The budget will be managed at an NHS board area level, but for services with a strong tertiary element—a strong specialist element—we expect boards to come together in regional groupings to address the way in which services should develop. We expect there to be a funding mechanism between the boards comprising the regions, which will allow us to provide sensible funding for specialist services. Part of our development is, therefore, the development of regional planning.
When will your papers on how you are going to manage the problem be published or announced? You are doing some work on it, as you said in your answer.
A draft version of the regional planning proposals, which the NHS board chief executives have developed, are currently being finalised and will come to us formally probably within a month.
I would like to move on to the subject of waiting times and the progress that is being made on them.
There are several gaps in the waiting times data, but we are taking action to address those. Out-patient waiting is a good example of where the data have been totally inadequate in the past; the same applies to cancer care, which you are describing. We can track progress because we can get information about the different stages and about delays but, in the past, that information was not recorded officially by the information and statistics division as we would wish it to have been. Perhaps Trevor Jones will have more to say about that, but we are generally aware that we have to work to get more comprehensive, official, published data than have been available in the past.
That is right. We have to work directly with NHS boards to identify how performance in cancer treatment is changing. If there is no routine data collection system in place, we work directly with NHS boards and identify how the service is developing.
I am really asking how you know that the target is achievable if the current audits are prospective and will not be evaluated until 2005. You have set a target that
There has been a lot of clinical involvement in the setting of that target, which is the same for the UK as it is for Scotland. The general view of clinicians is that the target is reasonable and achievable. However, I accept what you are saying about the current problem with data to back up that target.
The link between the targets and the budget plans is such that you are setting objectives and aiming for targets and the draft budget is giving us an idea of what progress has been made. How much of the 2004-05 budget will be spent on delivering the waiting times targets?
I will let Trevor Jones attempt to answer that because, as I said, it is quite difficult to disaggregate the budget for waiting times. The figures are locked up in the big staffing budgets for particular trusts and out-patient care is locked up in primary care budgets. A lot of the redesign work being done on out-patient waiting times is about things being done differently with primary care. Money for waiting times targets is all over the place—in the primary care budgets, in the trust budgets and certainly in the staffing budgets. That is my general preamble; Trevor Jones might be able to say whether the figures can be disaggregated. Certain streams of money are supporting the budgets to deal with waiting times; and the money going into the Golden Jubilee national hospital is an example of that.
We cannot identify how much of the NHS budget is spent on addressing waiting times. For example, how many NHS beds in one hospital should be classed as waiting time beds? It varies depending upon the number of emergency cases that are coming into the hospital and the number of planned cases being addressed. We can obviously describe some of the direct costs, such as surgical services, but we cannot put a number on the cost of addressing a waiting time target.
I understand that it is difficult, but do you know for certain that addressing waiting times is the best use of what is a fair amount of resources, as opposed to using them in health education projects, such as encouraging people to give up smoking so that they do not have to be admitted in the first place? How can you evaluate whether the money that is being put into waiting time initiatives is the best use of resources?
Obviously a judgment has to be made. I always say that waiting times is not the only issue that patients are interested in and then I proceed to talk about the wider quality agenda. However, no one in this room will question the fact that patients are also interested in waiting times.
In response to questions, you have talked a bit about nurse training, but I am particularly interested in the budget line called "Education & training other". We welcome the increase in the budget to address skill shortages, but one of my concerns is that the £6.14 million in the 2003-04 budget is more or less at a standstill in the budget for the following two years. Your letter responding to our questions from last week talks about how the budget for a number of allied health professionals comes from the Scottish Higher Education Funding Council, which might be part of the explanation.
We must watch the different budget lines, because over and above the two that you mentioned is the massive budget line for NHS Education for Scotland, which will increase to £225 million next year. That is highly relevant to our discussion. Much of that will go into the medical work force, but it is not exclusively for that work force.
That is where my concern lies. Your letter says:
I am taking over the chair of the group that examines recruitment and retention of allied health professionals. That group's first meeting since the election will take place on Monday 20 October. I have chaired the nursing group for the past two years, so I have been more closely involved in nursing recruitment and retention issues.
The cross-party group on mental health wrote to the committee to ask about the cost of implementing the Mental Health (Care and Treatment) (Scotland) Act 2003. We agreed that the issue would be part of our budget discussions, but we need the minister to play his role because we need some information from him.
As you will remember from the financial memorandum, some of the mental health money flows through local authority budgets. The £4.75 million is not the sum total, but the Health Department share.
Is that £4.75 million in the Health Department budget sufficient to meet what was laid out in the mental health act?
Obviously, the line reflects what was laid out in that act, but it will be supplemented in the ways that I have indicated.
Will any work be done on modifying the mental illness specific grant, which seems to have been frozen for the next three years?
I certainly unlocked that. I was concerned about the grant a year ago and provided for a 5 per cent increase, which is now being carried forward at the new level. As happened before, when the grant ran at one level for several years and was then increased, it is now running at the new level. I am pleased that we provided the increase after the grant had been frozen for so long, but we have announced just the one increase up till now.
Is there no intention to inflation-proof the grant?
That is not the way in which that grant has tended to operate, but we will take that into account as part of the mental health picture. The other issue that is relevant to this is the report that Dr Sandra Grant is to publish on the current state of mental health services, in particular in relation to the Mental Health (Care and Treatment) (Scotland) Act 2003. We will obviously want to read carefully the advice in her report.
Has the shortage of community psychiatric and psychological support staff that exists out there been addressed within the training budget lines, because we do not see it in the budget increase lines that you have talked about?
I have already flagged up the NHS Education for Scotland budget. A budget of £4,115,000 is provided for psychology in the disaggregated budget of NHS Education for Scotland, so that is a factor. Work is being done to increase the number of clinical psychologists as part of the much wider mental health work force picture. The mental health work force will be the first pilot for a key part of our new work force strategy, which will take an integrated and team-based approach to the development of the work force. A big piece of work is being done on that. We are conscious of the need to develop the mental health work force but, as I said, some of that money is supported by other budgets.
That is within the existing budget. We are not talking about training here; we are talking about employment out in the community.
Obviously, employment will be within the budgets of boards and trusts.
I assume that Sandra Grant's report will have budget implications. Is that the additional allocation to which you referred, or will you provide an additional, additional allocation?
We want to allocate some extra money to mental health but, as you will see from the tables, there is not an enormous amount of unallocated money lying around. There is some, because it would be foolish to have none—you know how many extra demands arise even within one year. It is sensible to have a certain amount unallocated, but it is not an enormous sum. Mental health is one obvious area in which we have to judge how much extra money we want to put in, by taking account of the partnership agreement commitment and Sandra Grant's report.
Expectations have been raised that there will be a response to Sandra Grant's report, which looks at unmet need, resource gaps and all of that. Why produce the report in the first place, if there is no intention of meeting unmet need? If insufficient resources are being allocated at the moment—and you indicate that that might be the case—how do you intend to meet the unmet need that is referred to in Sandra Grant's report?
Let us wait and see what the report says. I have already indicated that we need to consider some extra money for mental health, although it may well be—we do not know yet—that Sandra Grant's report will raise issues about how the existing considerable resources for mental health are spent. There is a long-running issue about the balance between the amount that is spent in the community and the amount that is spent in psychiatric hospitals. Let us wait and see what her report says. We will certainly respond to it.
I and other members have asked you what evidence you have on outcomes to show that money has been wisely applied. I am looking at table 5.05 and the money for research in 2004, which is just under £15 million. As I understand it, the chief scientist office, which receives that money, is the main source of research grants in health in Scotland. Your budget is £7.8 billion, and the amount of money that is going into the chief scientist office to do research—which I hope will provide the evidence base that we are all looking for—is 0.2 per cent of the entire budget. Is that enough?
Again, the issue is the way in which these things are presented. The figure in the table is slightly misleading, because it represents about a third of the budget of the chief scientist office. I do not have the precise figure in my head, but something like £33 million goes to trusts to support the research that is done in a clinical context. I know that the overall budget of the chief scientist office is £45 million-plus. I do not have the exact figure in my head.
At the top of page 76 of the draft budget there is a line for research support, which shows other parts of the budget.
So the two figures should be added together to get the overall budget.
I am not being difficult, minister, but my point is that if we have evidence it will assist you. That seems to be a pauchle to spend on research.
I understand entirely the point that you make. There are many lines within the budget on which I would like to spend more money. I know that people think I go on a bit about this, and that I am hard-hearted because I am not spending more money on research and hepatitis C and cancer but, at the end of the day, we are spending significantly more money on all those three areas than we were last year or the year before. We just have to make some choices because, if I come here and announce a major expansion of the research budget, you will immediately ask me from which area of patient care I have taken the money. I cannot disagree with you, but I cannot agree with you either, because we have to make those hard choices.
In my view, more money spent on research, analysis and evidence might mean that we spend money better than we do at the moment. I appreciate the complexities, but we may be penny-pinching in the wrong place.
I do not disagree with you. One thing that I have done since becoming Minister for Health and Community Care is increase the research budget, for exactly the reasons you gave. I gave extra money to the chief scientist office, I increased the money for clinical trials in cancer, and we provided the money to ensure that Scotland has the opportunity to join the national translational cancer research network, which we hope to announce soon. We are aware of the issues and we are increasing the research budgets but, at the end of the day, I cannot increase them as much as I want to, because I would then have to make a dreadful decision about which area of care to take funding from.
I appreciate that, minister.
Meeting continued in private until 16:20.
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