I welcome members, the press, the public and Audit Scotland staff to the 16th meeting of the Audit Committee in 2008. I ask everyone to ensure that mobile phones are switched off.
Do we also agree to take in private all future consideration of our draft report on the Auditor General for Scotland's report "A review of free personal and nursing care"?
“Living and Dying Well: <br />A national action plan for palliative and end of life care in Scotland”
Item 2 concerns a section 23 report on palliative care services. I ask the Auditor General to introduce the item.
When the committee considered palliative care, we gave an undertaking that, once the Scottish Government had published its statement on the matter, we would give a brief outline of the significant issues. Angela Canning is happy to do that, if it would assist the committee.
The Audit Scotland report on palliative care, which was published on 21 August, made a number of recommendations about improving access to specialist palliative care for everyone who needs it; providing education, training and support for generalist staff; applying good practice guidance everywhere that patients receive care; and putting in place better links between services.
Thank you for that.
I would like to clarify what is meant by:
The action plan makes reference to a number of recognised tools and techniques that boards should use. Recommendations that are targeted at boards, at community health partnerships and at council partners should result in consistent records being kept of patients' needs, how they are addressed and what has been put in place as regards carers' assessments. A standard set of information should be recorded for all patients who are identified as having palliative or end-of-care needs and their carers.
In other words, the recording of consistent information will evolve from the actions that are outlined. There is a big difference between driving the situation and allowing matters to evolve. Surely the boards must be aware of the targets that they are aiming at.
Yes.
One thing that bothers me is that although nine of the 26 recommendations have been addressed, 17 have not. Although your briefing looks good at first, alongside the heading "Addressed" are categories such as "Partly addressed", "Mostly addressed", "Work in progress", "Implied/work in progress", "To be addressed", "future development", "Not specifically addressed", "Not addressed" and "Addressed/Work in progress". What at first appears to be solid progress begins to break up on further examination.
In the briefing, we tried to outline issues that are specifically addressed in the action plan, but you will see that the third column in the table is "Other developments/Further information", so even though it might not be detailed in the action plan, we are aware of other work that is going on, such as the short-life working groups that are being set up to progress specific actions.
You can probably understand our concern about vagueness. Everyone wants the finest palliative care to be available, but I am not sure that we have been provided with a clear pathway towards that. There is a lot of in-built vagueness. Although Audit Scotland made 26 recommendations, 17 of them have not been addressed. I would have liked much more precision on the way forward.
Before I bring in Willie Coffey, I would like to ask what the key issues are that have not been taken into account or addressed.
The only issue that we identified that the action plan did not pick up or address specifically was that of ensuring that boards have robust commissioning arrangements with their partners for the delivery of palliative care services and that those arrangements are monitored to ensure value for money. Through the review, we picked up on the arrangements that boards have with the voluntary sector, for example, and the contracts that are in place there. We had difficulty identifying exactly what those contracts looked like, how much funding was going to individual providers and how that was monitored. We could not see any specific actions that related to that recommendation.
There is also the issue of consistent recording.
We have highlighted in our report that three recommendations were not covered, the most important of which relate to information recording, and commissioning and monitoring arrangements, without which there cannot be absolute certainty that the implementation of the strategy is on track.
Those are three fairly big issues, which I will come back to.
The question how palliative care services are delivered in remote and rural communities was not specifically addressed. Although it is a generic strategy, there are presumably peculiar needs in those communities, which, as I understand it, were not picked up by the Government's action plan. I was hoping that there might be further details on that.
The introduction to the action plan makes it clear that the plan is expected to apply equally to people throughout the country, wherever they live and whatever their condition. There are no specific recommendations about how the plan might be delivered in remote and rural communities. We would expect that when the boards develop their delivery plans they will spell out how the plan will be delivered locally. The boards are due to produce their delivery plans by the end of March next year. We will want to consider those documents to see how the issues in the action plan have been picked up. It is very much in the spirit of the action plan that we have not got down to that level of detail and described how the action plan might work for such communities.
My question has perhaps been addressed. I am sure that we are all aware of the large contribution of the voluntary sector in providing palliative care. As my committee colleague Andrew Welsh said, it is a matter of concern that we do not have a process in place to ensure that joint working between the health service and the voluntary sector takes place and that we are getting value for money. The issue of resources is a difficult one for the voluntary sector in particular. Perhaps we can pursue that further, convener.
We will decide later in the meeting what we want to do about the action plan. Are there other issues that require clarification at this point?
Paragraph 38, on page 18 of the action plan, says that
A new national e-health group has been set up and is looking at issues around palliative care. I believe that that is being led by the national clinical lead—that is a key appointment by the Government. The e-health group is one of the short-life working groups that have been set up and is trying to explore electronic communication and more ready access to information at points of transfer, such as between in-hours services and out-of-hours services. The action plan talks about involving all partners in that discussion—boards, the voluntary sector and council partners. It is work in progress.
I wish that the Government would find a better term than "short-life working group", which is a bit inappropriate.
In our work, initially we want to look initially at what is happening in relation to processes. We want to consider what the delivery plans look like, what is coming out of the working groups that are being set up and what is happening with care for elderly people in hospitals and care homes. The report focuses on training for generalist staff, such as general practitioners, district nurses and staff who work in care homes. We know that there has been action on that. NHS Education for Scotland is recruiting somebody to lead a new programme of work to develop that generalist training. We are starting to see some of the actions that should put in place the processes that will lead to improved outcomes and improved quality of care for the groups involved.
That is another example—like the example raised in Mr Coffey's questions—that shows why it is so important that the health service has consistent information. It needs that information so that it can monitor what is actually happening in relation to palliative care, rather than just the processes. That is one of the gaps that we have highlighted.
That is going to be followed up.
Yes.
I thank the Audit Scotland staff for their contribution.