“Overview of the National Health Service in Scotland”
Agenda item 4 is an opportunity for a discussion in which members can raise how we might go forward with our evidence and general lines of inquiry in regard to the Auditor General for Scotland's report "Overview of the National Health Service in Scotland". George Lyon requested such an opportunity and I was happy to put it on our agenda. We want to obtain a sense of how the evidence sessions should be structured. I invite George Lyon to make the first contribution.
If we are going to get something worthwhile from the two evidence sessions that we will have with the NHS boards, it might be worthwhile to signal to them the areas on which we would like them to provide some in-depth information in order that they can come to the committee prepared.
During our discussions, the Auditor General raised an issue about transparency in relation to the dissolution of trusts, the move to unified health boards and the identification of rising cost pressures. That seems to be a fundamental issue and we need to signal to the boards that we would like them to spend some time on that.
I would also like the boards to give evidence on the cost pressures that will come into the system, whether those relate to the new general practitioner contracts, junior doctors' hours, consultants' contracts or the European working time directive. From my reading of the Auditor General's report, it seems that the Scottish Executive Health Department—at a high level—does not have a handle on what those matters will cost. What we need to find out from the health boards is: first, how much of the extra money that is being pumped into the system will be taken up by those matters; and secondly, how much extra output there will be from the service on the ground. That is certainly the question that the general public are asking; they are willing to pay extra tax so that more money can go into the health service, but they want there to be better outcomes and outputs.
The committee should be drilling down into those matters. One way of starting that process is to speak to the people who are charged with the delivery of services on the ground on behalf of the Scottish Executive, so that we can hear their views—and detailed information—on the deals that are about to be implemented, which are driving so much of the health service's agenda in certain directions. Do the health boards think that the extra money that is being provided will be enough to implement those new deals? What extra output will they be able to deliver by 2006-07, when the peak of the new health spending starts to get into the system? That is a fundamental point. Perhaps a discussion with the boards will enable us to pick up some of the issues that we will need to take up with Trevor Jones at a subsequent meeting.
Members are free to comment and I will then ask the witnesses from Audit Scotland to give their views.
I missed the committee's previous meeting because I was away on business with another parliamentary committee, so I apologise if I am raising matters that have already been considered.
I want to comment on the format of the proposed evidence sessions and in particular on the issue about inviting Trevor Jones back to give evidence. This might seem unorthodox, but I will explain my reasoning in a second: has any thought been given to the possibility that we might ask Trevor Jones, or another member of the Health Department, to be present while local health boards give evidence? One of the real limitations of the evidence-taking process that we follow in the Parliament is that it is very linear and depends on our going back to the Executive later to test the views that individual boards have expressed to us. That process does not provide an opportunity for alternative perspectives to be shared during a committee meeting. It might be slightly unconventional, but when committees have experimented with bringing groups together instead of hearing from them in separate sessions, the committees have gleaned a great deal more understanding.
My other question relates to the committee's discussion at an earlier meeting, at which I was present. I wondered whether the committee reached a final agreement that it should invite just two health boards to give evidence. I am concerned that, although we have opted to invite Lothian NHS Board for reasons that I think everybody agreed on, we will not have the opportunity to consider its evidence alongside that of Tayside NHS Board or Greater Glasgow NHS Board, which also run major teaching hospitals, for example. If the committee has already considered the matter, please tell me. I watched most of, if not all, the committee's previous meeting on the webcast later, so I have done my best to catch up.
That is sad.
Very sad, yes.
I will take Susan Deacon's points in the order in which she made them.
First, the intention behind the decision to take evidence was to ascertain the health boards' perspectives on the pressures that they are under. Indeed, we have not yet confirmed that we will invite Trevor Jones to give evidence, although there is sympathy for that proposal and we will discuss it and take a decision today. We did not consider the idea of running evidence sessions in tandem, but I think that such a format might be inhibiting for the health boards. It is right and proper that, after we have heard from a number of boards about their concerns and difficulties, we should explore the matter further. At that point it would be useful to invite Trevor Jones along. We might use the model that Susan Deacon proposed at another time but I would not recommend it on this occasion.
We decided to invite three health boards to give evidence: Lothian NHS Board, because we wanted to understand the particular financial pressures that a health board that runs teaching hospitals is under; and Borders NHS Board and Ayrshire and Arran NHS Board, because we wanted to hear a different perspective from boards that serve rural areas and that, to a certain extent, face pressures that are associated with the fact that they serve areas that are adjacent to urban areas. For instance, many people who live in the rural area that Borders NHS Board serves do not work there but commute to other areas. The committee chose to invite those three health boards to get a broad sweep of the different pressures that boards are under. I certainly do not suggest that we revisit our decision at this stage; however, we could do so after taking evidence, if we think that the evidence that we have heard is somehow incomplete.
On George Lyon's comments, it is important that we establish whether the uplift in funding is achieving the improved services that the public think and expect that it will achieve. The public—and the politicians who deliver the extra money—would be severely disappointed if the money did not make a difference. It would be helpful to ascertain as early as possible whether salaries, pay settlements and regulatory changes are absorbing the increase in spending, to the extent that we will see no change in the quantity or quality of the services that are provided. I suggest that the committee takes up that issue.
First, I support George Lyon's comments.
Secondly, there might be considerable merit in Susan Deacon's suggestion. The objection has been raised that health boards might find themselves constrained if evidence sessions were set up in the way in which she suggests. However, if we consulted the boards and found that they thought that such sessions would be a good idea, would the suggestion not be worth pursuing?
If there is no appetite in the committee to change the system, I will not press for it to do so. However, I want to tease out the convener's comment that health boards would be inhibited by the proposed format. We must remember that our meetings take place in public session and that we are inviting senior managers, some of whom are on six-figure salaries. Whether Trevor Jones is watching our meeting on the webcast, reading the Official Report or sitting at the table 6ft along from those managers should not make a material difference to their ability to speak honestly and openly about their views.
By the same token—lest anybody think that I am simply talking about the health boards—given that the Executive frequently expresses a different view about the impact of decisions, for example, on big contracts, it too should be able and willing to express those views when local managers are sitting six feet away, rather than just express its views across the airwaves or in correspondence. I note that point as part of a wider point about how we try to debate and understand issues in Scotland, and I challenge the assertion that anybody should be inhibited because of the presence in the room of someone else during a discussion, especially as the whole discussion would take place in public.
One of the biggest issues that we will have to address in this perennial debate over health service funding is how we get away from the finger pointing that takes place in which the national service blames local services and local services blame the national service. Meanwhile, patients are tearing their hair out, very often at elected members, over the question whether improvements are being made.
Having missed the previous meeting, I have no intention of pushing and pushing to change evidence-taking sessions that might already have been established. That said, I would like to think that we could at least keep an open mind about bringing some of these different perspectives together in the same room. I genuinely think that such an approach would enable us to move forward on some of these debates.
As I have said, I have an open mind on the matter, but that relates to what we might do in future, not to the decision that we have already taken.
As for whether witnesses will be inhibited, I think that I said that witnesses could rather than would be inhibited if everyone were put together in the same room. I was just flagging up that, no matter how professional we might want our health board chief executives to be, I do not know any of the people who will come before the committee and therefore cannot say whether they will feel inhibited or not. I hope that they will not feel that way, but one cannot predict anything in that respect. On this occasion, I would prefer their attention to be focused on our questions rather than on anything else. After taking evidence from the health boards, we might find that we can take a different tack altogether in future.
I disagree with Susan Deacon. For this inquiry, we decided to take evidence first from Lothian NHS Board because of particular issues that members raised and then from health boards in the west of Scotland or in rural areas. We decided that we did not want to take evidence from Tayside NHS Board because that has been done to death and it needs to be left to carry on with its business.
It would be wrong to invite Trevor Jones to the meetings with Lothian NHS Board and with the other two health boards. Susan Deacon suggests that questions will inevitably arise from their evidence that Mr Jones will have to answer. That is not always the case. After hearing the evidence, it will be for the committee to determine whether it requires evidence from the accountable officer, Mr Jones, and the various issues on which it might seek that evidence. We need to go through the process before we can make that decision.
I think that we have already taken the decision on Susan Deacon's suggestion about bringing the health boards and the Health Department together.
My main reason for asking the health boards to prepare for their evidence sessions is that we do not want them simply to give us their opinions about how things are being delivered. We want them to come prepared with facts, which we will then take up with Trevor Jones. We know that the boards will appear before us and make their points as vested interests. Indeed, those of us who have been involved in organisations that lobby politicians—or whoever—know that the job of such organisations is to represent their vested interests and paint the best possible picture. However, it is up to politicians to demand facts and to probe our witnesses with hard questions to ensure that they are able to substantiate their comments. That is why I wanted to write to the health boards early on, highlighting the areas that we want to deal with and asking them to provide us with facts or to have those facts to hand when we start to delve into the matter. It might even be useful if they provided a paper before the meeting in question, so that we had some time to look at it.
At this point, I invite the Auditor General to comment on what we might consider in our evidence gathering.
I invite Caroline Gardner to brief the committee on this matter.
I will begin where George Lyon started and finished the committee's discussion by considering the questions that might be put to the three boards that have been invited to give evidence. It seems to me that the questions that members might want responses to clearly follow on from the reasons why the particular health boards have been selected to give evidence. Members were interested in finding out the cost pressures that all three boards are facing; how well they are dealing with those pressures; and the challenges that they face in that respect.
For example, members were particularly interested in Lothian NHS Board because of issues that sprang from the overview report, in particular the board's significant reliance on non-recurring funding to achieve a financial balance and the big shifts in the forecast of its financial position over the next few years. Members expressed an interest in finding out what was causing the situation and how it was being managed.
Members also wanted to learn from Borders NHS Board how a rural board was managing to achieve financial balance and to find out whether there might be any lessons from integrating the trusts and the board in that area. As for Ayrshire and Arran NHS Board, members wanted to take evidence from a board that had to deal with significant levels of deprivation. The committee wanted to understand how the board was dealing with those issues and achieving a financial balance by using a significant accumulated surplus from the previous financial year.
It might be worth reminding the committee that we are planning to produce a report in May that builds on the first overview report by providing more background information on trends of expenditure, activity, outcomes in the health services and so on. Although that report will not answer any questions about what is happening with all the additional funding that is going into the health service, it might—along with the evidence from the three health boards on managing new cost pressures—begin to cast some light on questions that members might want to ask the Health Department. As a result, we are very happy to work with the clerks to produce on each of the boards some areas of questioning that we can submit for the committee's approval. However, members might want to think about deciding on when to take evidence from the accountable officer of the Health Department, Trevor Jones, in the context of the publication of the second overview report and the additional background information that it will contain.
Thank you. That was very useful.
Our intention was to distil the evidence that we receive from health boards into questions for Mr Jones. However, as a further overview report will be produced in May and our work programme shows that some dates in May are available for meetings, we might achieve a great deal if we carried out our work in conjunction with that report. For that reason, I ask the committee to agree today to invite Trevor Jones to appear before us and to flag up that we will ask him to appear on one of the two available dates in May. We can confirm the date nearer the time. Are members agreed?
Members indicated agreement.
The clerks have suggested that we should clarify whether we should seek written evidence from the health boards in advance of our meetings.
Members indicated agreement.
That is a definite yes. We will invite—
Factual information.
Yes. We will invite the health boards to provide us with factual information.
I also want to clarify with members whether, when we talk about seeking evidence from health boards, we mean the boards that we will invite to come before the committee.
Members indicated agreement.
Otherwise, we might confuse matters. I just want to ensure that no member misinterprets what I am saying.
We move on to agenda item 5, which we will take in private. I ask members of the press and the public to leave the meeting.
Meeting suspended until 11:40 and thereafter continued in private until 12:12.