We move on to item 4, which is consideration of the Executive's response to our fifth report in 2005, on the "Overview of the financial performance of the NHS in Scotland 2003/04".
The Executive response to our second recommendation, which highlights the "building financial pressures" in the national health service, is "Noted". However, although it then mentions
You might wish to raise the matter next week.
Unfortunately, convener, I do not think that I will be here next week. Perhaps someone else will pick up the issue.
That is worth knowing.
I want to make several general observations not just on the papers before us but on the work on which we have been engaged for some time now.
I entirely share your observation with regard to the tone of the response compared with that of the press release that was issued on the day that our report was published. The press release was from a minister, but the response is from the accountable officer at the head of the department. We deal with the accountable officer and we do not get involved in the policy and the political to-ing and fro-ing. We can fairly say that such a response from the head of a department is to be encouraged. It is the type of response that we want and if other departments behave in a similar fashion in future, we will be able to have meaningful and open discussions. Such a response takes some of the politics out of the debate, which is the way in which the committee works. Other committees, such as the Health Committee and the Finance Committee, deal in policy terms and can have the political discussion; it is right that they do that.
I wish to update the committee on reports that will be coming to you over the winter. In December, we will publish an integrated overview report on the NHS, which will bring together, in one report, our previous performance report and the financial report. Following that, early in 2006, there will be two quite big reports: one on waiting times, which will bring up a lot of issues to do with sustainability and capacity for change in the system; and another one on how the consultant contract has been implemented. In many ways, those three reports together come back into the arena of the comments from Kevin Woods.
Kevin Woods will attend our away day, which will provide an informal opportunity, as well as formal ones, for us to discuss how we can facilitate better analysis and better discussion about these issues. That is on 3 October, which is not far away, so there will be an opportunity soon to have further discussion with Kevin Woods. Are there any other points from members on the report?
As the second-newest person—this is only my second meeting—I will probably be going over things that either are inappropriate or have been gone over before, because I was not party to the original work. A couple of things stood out for me. One is non-recurring funding, which the committee recognises is a problem—as do I, as a former NHS employee—because health boards have come to rely on it. However, in response to paragraph 33, which states that boards
Keeping an eye on it would not be.
I want to pick up on Eleanor Scott's point about non-recurring funding. I share her concerns about the response on that point. If non-recurring funding is not going to be in the accounts, how will we identify it? It is worth repeating that the committee said that there is a role for non-recurring funding in budget management. We are not saying that it should not happen; we are suggesting that it is important to identify it, so that we are aware of it and are able to deal with it in a strategic way that ensures that boards do not become reliant on it and make themselves vulnerable. Unfortunately, the response did not instil me with confidence that the point had been accepted. We might wish to address that with Kevin Woods next week, so I will not labour the point now. However, we need to be clear that we are not saying never; we are just saying that it needs to be properly managed.
I agree with both those points, which are well made. I emphasise that our concern about non-recurring funding is that we need to be aware of what is happening, so that any structural deficit is not disguised by non-recurring funding. There has been evidence in the past that the reliance on non-recurring funding has masked financial management problems in health boards.
Once again I raise the issue of data collection. Notwithstanding where we go, and the broader issue of various reports on NHS performance or our informal discussions with Kevin Woods, the committee should seek a further formal update on the issue. There is universal agreement that the data that are collected on the performance of the NHS in Scotland are not up to date or fit for purpose, which leaves hanging the question why that is the case.
The committee has made that point a number of times with regard to different reports that we have produced. We will have to ask about the matter next week. It is also something that we have asked to discuss informally at our away day. Opportunities for discussion therefore exist. We must keep on top of the issue. Like you, when I saw the questions that might be asked about the collection of data, I did not get the sense that the information that we will receive will be any more helpful to us.
I give my usual apology that I might ask a daft-lassie question, as I am new to the committee.
You are a former convener of the Health and Community Care Committee, however.
As a former convener of that committee, I agree with Mary Mulligan that the staff are the key to the delivery of the service and to any change in it.
Obviously, I cannot answer that question. What you say might be interpreted as straying into policy, but you finished by making a general point that affects outcomes across the board rather than by giving a specific individual example. Pay awards are a matter of policy, but we could concern ourselves with the general outcomes. We could see whether there are perverse outcomes when we see the statistics, which could lead us to ask questions. There is an issue about how agenda for change will be delivered and whether it will be delivered in a way that will avoid outcomes that we would regret. You can have every confidence that we will be able to find a way of phrasing the question that would be permissible.
It is difficult to have an objective measure of staff satisfaction, but there are certain surrogate measures of staff dissatisfaction, which I am not sure we get routinely, such as levels of sickness, absenteeism and early retirement. It might be nice to monitor those in the NHS over time. As others have said, the staff are crucial in delivering the NHS; it will only work if it has happy and committed staff. It would be nice to get those figures. They must be available; somebody must have them, although I do not know whether they are collated.
If we were going to get those figures, the one caveat is that we would probably have to take into account the fact that satisfaction in one health board might be different from satisfaction in another. One would expect that the difficulties, of which we have had evidence, in Argyll and Clyde NHS Board would certainly have led to dissatisfaction among its staff, given that they were working under the cloud of a large structural deficit. In other health boards where such situations have not occurred, similar pay arrangements and working conditions might produce a greater degree of satisfaction among staff. As long as we do not end up comparing lemons with pears, that information would be useful.
Not really. It is interesting to hear the points that the committee has noted. We are paying a lot of attention to them, because we are considering some of the issues that have been raised. On the staff data, there are mandatory statistics on sickness, staff turnover and the like, but they are not necessarily collected in a consistent way throughout the health service, although I think that the health service is addressing that. We take on board all the points that have been made. We are considering those issues in a number of studies that we are doing.
I want to pick up on the point that Barbara Hurst made about inconsistencies. In paragraph 81 of our report, we express our concern about the roll-out of successful initiatives. It is interesting that the department agrees with us, but it goes on to say that Scotland's health care system is no different from any other in the world. That is fine, as long as we are aware that we need to continue to strive to be at the forefront.
That is a good point, which I am glad you made today if you are not going to be here next week.
I will try my best to be here.
I appreciate that, but if you are not we will raise the point on your behalf.
Something has just occurred to me. May I ask the witnesses from Audit Scotland a question?
Of course.
Barbara Hurst said that one of the other pieces of work that Audit Scotland is doing is on the consultant contract. That is covered in the report to an extent, because it mentions that the contract is based on negotiations at the United Kingdom level. The Executive's response is that that was the right way to go. Is Audit Scotland considering whether it would have been beneficial to the NHS in Scotland if we had gone our own way and negotiated a settlement with our own consultants? Also, is that something that the Audit Committee has looked at?
Again, we tend to look at the delivery of such decisions. The contract was initiated at the UK level, but was enough account taken of the different work practices of Scottish consultants to allow us to interpret what the likely cost would be? That is the question that the committee considered. Our concern was that we needed to explore whether enough attention had been paid to the different hours and work structures of consultants in Scotland and whether that had been built into the estimates so that they were valid and so that the outcomes tied in with them. The evidence suggested to us that not enough attention had been paid to Scottish working practices. I am happy to ask Barbara Hurst to say a little more about where Audit Scotland's inquiry into the consultant contract is likely to go.
We have not looked at whether it would have been wise for Scotland to go with its own contract, because that is a question of policy and we do not have a remit to look at that. We have considered local implementation of the contract, the costs and the question whether any work is being done on the benefits to patients. Interestingly, we also surveyed all consultants in Scotland and we had a tremendous response—surprisingly, in some ways. We are now analysing that response. It will give us a richness that we might not have had otherwise, because we have a lot of information about how the contract is perceived by the people whom it affects.
It sounds as though we can await that report with much anticipation.
May I ask a brief question to Audit Scotland?
Certainly.
When can we expect to see the findings of your work on out-of-hours care, following the changes to the general medical services contract?
Not for a while. We are not due to start it until early next year and I suspect that it will be quite complicated to do, given that we will have to go into a number of different services. The work will not be available until late 2006 at the earliest, although we might find a way to feed things back. We have not thought about the scope properly.
Although I understand the reasons, I am concerned that it will be a considerable length of time before Audit Scotland completes that work. There is a question about how we can get some information sooner than that, particularly about the development of out-of-hours cover, which we and others have identified as a critical issue that has implications for various parts of the NHS. I would welcome it if Audit Scotland could suggest some way of, as Barbara Hurst said, feeding back observations. I am not talking about next week or next month, but before the end of 2006.
Although it is not for us to determine which subjects Audit Scotland considers or how it conducts its inquiries, we can certainly state that we would naturally want the issue to be considered sooner rather than later, given that, were we to take up the matter—depending on what the Audit Scotland report said—we would probably not be able to do so until early 2007, which clearly would create difficulties. The point has been well made—perhaps we can revisit the matter informally at a later date.
We will try to consider the issue, but my team would kill me if I overcommitted them.
We would not want that.
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