I welcome the press and the public to the 14th Finance Committee meeting of session 2. I remind members and others that all pagers and mobile phones should be switched off.
Yes. We sent a submission, but there might have been a problem with your receiving it. I have further copies with me.
It would be helpful if those could be given to the clerks. It might be helpful to take the COSLA evidence first and then move on to the NHS Confederation. Hilary Robertson will still be here so she will have the opportunity to speak. If it is acceptable to members, we will take her opening statement after questioning the COSLA representatives.
My colleagues and I value the opportunity to be here today. Our comments must be seen in the context of COSLA's wanting the bill to work. We have already seen changes as a result of the consultation and we are encouraged by those changes. We had the opportunity to lay out some of our concerns and questions at last week's Education Committee meeting, which was a helpful and productive discussion.
Thank you.
On your second question, there can be very little agreement, because we have not seen the definitions yet. My colleague was on the working group, so he can give some idea of the issues that it covered.
I recall that there were three meetings that involved representatives from COSLA and other education authorities. I understand that two meetings were held that involved representatives from the health sector, although other members of the panel will perhaps be able to comment on that.
The Executive's information on children with such needs must necessarily come from COSLA in the first instance, because schools have the most immediate contact with the children. How can you come up with one assessment of what might be required and the Executive can come up with an entirely different one?
The first point is that the implications for special educational needs of the definition of school education, as introduced by the Standards in Scotland's Schools etc Act 2000, are untested. In a sense we are all in the dark on that.
When you consulted local authorities on the implications of the bill, did the process extend beyond the headquarters of each different local authority making an assessment that was based on their existing records under the current scheme or was there an attempt to take the process out to schools and to take into account the idea that, if the new system is introduced, head teachers, or perhaps even classroom teachers, will have some input into the number of children who might be affected or who could benefit from the proposals?
The Executive appointed a consultant who might have done some work in schools, but the discussions that took place with local authorities were held in a short time frame and were subject to confidentiality agreements. That meant that the process was largely confined to desktop exercises within local authority headquarters.
In South Lanarkshire, head teachers of schools were consulted so that we could get more detail about the trawl of pupils who were attending school. That is what our information was based on.
COSLA got the returns in from the consultation of local authorities. Was there a difference between the procedures used by local authorities to develop the assessments and produce the figures? Did the kind of exercise to which Donald Thomas refers lead to a different outcome? How did the outlier figures, such as that from South Lanarkshire Council, compare with the desktop estimates that were arrived at in other local authorities?
To be honest, that analysis has not taken place. The Executive holds that information. The information was based on the consultation exercise that was carried out earlier in the year. There was a significant range of responses from authorities, which was not unexpected given the uncertainties with regard to the context and the definitions.
The bill's aims are worthy. It seeks to move us from recognising special educational needs, which have been interpreted fairly narrowly, to a much wider definition of additional support needs. However, as is so often the case, it is difficult to translate worthy aims into practical measures. I am concerned that the legislation may tie up our teachers in a tangle of tartan tape.
We do not need to go back that far. As I indicated, we have a good starting framework. The aspiration that the bill expresses is good and we want to work with it. However, we are concerned that the code of practice, which will help to make the bill work, and the legislative guidance need to be bottomed out before we can understand the costs associated with the bill. That is the key issue. We are saying that if we interpret the bill in one way, it has particular consequences, but if we interpret it in another way, it has different consequences.
You are suggesting that scrutiny of the bill should proceed and the financial memorandum working group should reconvene, but that we need to see the code of practice. I agree. We also need to see the regulations associated with the bill. Is it COSLA's position that we cannot really make progress until we see what the code of practice says and that the Executive should publish the code of practice before we go any further?
Clearly, having the code of practice would make the lives of all of us easier and more focused, because it would provide us with a grasp of the issues. At the end of our submission, we say that it would be helpful to have a lead-up period of at least two years before the bill is implemented. If we want to get the legislation right, we should take our time about it and do things well. We do not need to go back to the beginning of the process, but we must ensure that we take the journey together rather than in conflict.
I appreciate what you say. We all want to be helpful. No one quibbles with the aim of the bill, which is worthy. The legislation can help a great many kids if it is thought through.
As we have already said, we argue that the code of practice and the legislative guidance should be in place before the legislation is implemented. If that means taking longer to implement the bill, we should do so.
I am sorry to quiz you on this issue again so soon after last week's meeting of the Education Committee.
That is okay.
I would like you to clarify some of the figures that were thrown around a moment ago. At the moment, about 2.3 per cent of children have a record of needs. In the financial memorandum, the Scottish Executive assumes that half of those children—plus perhaps another 0.3 per cent of the school population—will need a co-ordinated support plan. The estimate is that between 1.5 per cent and 1.8 per cent of children will need a CSP. You estimate that the figure is likely to be at least 3 per cent. In that estimate, are you assuming that every child who currently has a record of needs will probably need a co-ordinated support plan? Is it unlikely that anyone who has a record of needs would not be eligible for a co-ordinated support plan?
Based on the records that cross my desk and that I sign, we assumed that at least 80 per cent of children who have a record of needs would qualify for a co-ordinated support plan. When we take into account the additional children and young people who might be captured by the definition, the figure rises to at least 3 per cent of the school population. I emphasise that that estimate was made prior to the insertion of the word "or" in section 2(1)(c). That change might extend very significantly the population that is eligible for a CSP.
There is a lack of clarity about that change. In evidence, the Executive appeared to return to its previous definitions. We must seek clarification of the point from the Executive.
We could not bear such a cost. We are talking not only about cash resources, but about the availability of time for staff to manage cases. It is not clear who will manage cases. It looks like teachers might do that, but teachers do not have the same level of training in managing cases as have social workers, for example, so training would be needed. In addition, complex tasks must be undertaken in holding together the different agencies that deliver services to a child and ensuring that those services are delivered in a co-ordinated way. That may sound obvious, but we have recent experience of cases in which that has not happened.
Through virtually every line of COSLA's submission, alarm bells ring about the cost implications for local authorities. Some cost implications arise because you disagree with the Executive's view and others arise when you throw up your hands and say, "Is this or that included?"
I was involved in the financial memorandum working group, albeit briefly. I missed the group's first and third meetings, but hit the second meeting. I was impressed with my ability to pick up on what are technical educational matters for me, because I am a social worker.
Is that one aspect that you want the financial memorandum working group to be reconvened to consider?
Although I was absent from two meetings, I fear that a cursory glance was given to the financial memorandum and that later chances to offer input were not substantial.
COSLA's submission states:
That must be seen in the context of the submission's opening paragraph, which refers to the aim in the Standards in Scotland's Schools etc Act 2000 of enabling each child to develop to his or her fullest potential. That is a high bar, which is good. The submission then refers to barriers to learning. If those two aspects are combined, it could be argued that a child's barrier to learning and to fulfilling their potential is that he or she does not have access to teaching in his or her first language. One can see that conclusion and would therefore want to ask for that to be clarified, but we need it to be clarified in the code of practice or the guidelines.
Obviously the inclusion of such provision could have massive cost implications.
That is correct.
Several head teachers in my constituency to whom I have spoken have expressed concern about the intentions that lie behind the bill and about whether the process of recording co-ordinated support plans will follow the same track as that for records of needs, whereby parental pressure as much as professional diagnosis influences whether a child is encompassed within the system. Head teachers find that their perceptions of the relative needs of children in the class do not link with entitlement as worked through the system.
That concern runs through COSLA's response. Several strands run through the bill; some have been picked up and dealt with in great detail, but the strands have not been woven together into a coherent whole. In the absence of that, the danger that some aspects could run out of control is real. That might involve scope for conflict among schools, authorities and parents and resource demands. In such a situation, the danger is inevitable that a disproportionate amount of resources will be diverted to those who pursue avenues that the bill might offer.
I want to be careful not to stray into policy, but you seem to say that the way in which the system has been conceived creates the risk that some children whom we ought to target might be missed. If the mechanisms for running the system—not only the diagnostic aspects, but the tribunal aspects—were used to the extent to which they could be used, they could have a substantial further resource implication that has not been tested.
That is correct. We are concerned about pressures that the tribunal system and the mediation system will exert—it is clear that resources will be tested. Parents who have had to fight for everything for their kids will want to fight again—which is absolutely understandable—so they will test the system. We need to ensure that the system is robust enough to meet their aspirations and that it does not put such pressure on schools that they must spend all their administration time on a particular cohort of kids at the expense of other kids.
I want to ask about transition costs for moving from records of needs to the new system. Do you have any estimates of costs for simply moving children who are currently in the record of needs system into the CSP system? What might the costs be for local authorities and other people?
The situation is currently so fluid that no costing has been done on the transition from one system to another. We have costs for the current record of needs system and for what we think will be the new system, but no interim costs.
Nearly every organisational change of such a kind has substantial transitional costs. It is one thing to estimate the costs of the old system and then estimate the costs of the new system, but unless a bridging process that takes account of transitional costs is considered, there will not be a proper estimate of costs.
That is correct. Because of the lack of clarity, we cannot begin to work out transitional costs. If there is to be a transfer to a system that will have 0.5 per cent of kids on CSPs as opposed to 3 per cent, transitional costs will be massively different.
CSPs are the largest costs in the summary table in the financial memorandum, although they might not be the largest net costs if costs for the records of needs are deducted.
I would need to refer the matter back to Martin Vallely, because the City of Edinburgh Council probably has more detailed and up-to-date information than we have. However, I think that we can work with the figure of 80 per cent conversion from records of needs to CSPs.
The bill's financial memorandum does not appear to have been changed to reflect changes in the substance of the bill, which further underlines our concerns about the need for more work to be undertaken.
What do you mean by that? I would like to explore that matter further. Section 2(1) of the bill, as introduced, states that a child or young person requires a plan for the provision of additional support if
I refer to section 2(1)(c)(i). In the previous draft, there was an "and". There are other substantive differences; for example, the introduction of dispute resolution does not appear to be reflected in the financial memorandum, nor does the entitlement of parents to appeal for specific assessments, yet that appears to have been the basis for the estimates that a CSP would be less costly to produce than a record of needs. If parents have the right to request such assessments, I suggest that any savings will be marginal.
So the substantive difference between "or" and "and" in section 2(1)(c)(i) relates to the involvement of other agencies, which could capture more cases.
Yes, because other functions of the local authority are included. Using "and" would mean that if a child required education and social work support, it would not qualify for a CSP; however, with the change, the child would qualify for a CSP.
That would significantly increase costs.
I would like to say something for clarification. The Education Committee needs to explore that matter, because the difference is significant. When the Executive was questioned, it reiterated that no child who did not have input from another agency would be entitled to a CSP. The document that came out after the consultation implied a significant change in direction, but officials seemed to deny that at the Education Committee, which is rather confusing.
Martin Vallely is obviously not happy about that issue.
The bill's wording is unclear—it refers to "the education authority", "the local authority" and so on. Matters certainly require to be clarified.
More Holyrood howlers, I suspect.
My second question relates to the bill's assumption that pupils are static in local authority areas. Officers in my local authority area have raised the issue of pupils who move into a new local authority area, which will require work to be carried out and could put on that local authority a financial burden for which it had not budgeted. Will pupils who move from one local authority area to another be a widespread problem, given the fact that the financial memorandum states, in effect, that the matter simply concerns the reorganisation of existing budgets? [Interruption.]
I have been told that there are problems with the sound system. I therefore suspend the meeting for a couple of minutes.
Meeting suspended.
On resuming—
I understand that we have now got our sound back, so I hand back over to Jim Mather. Would you care to repeat your question, Jim?
If the financial memorandum working group were reconvened and had a clearly defined code of practice, how confident would you be that steps could be taken to converge with and adhere to the Scottish Executive's original estimate of costs?
I am not confident that that would be the outcome unless very tight specifications were applied to the circumstances, in which additional resources would flow from a co-ordinated support plan or the attendant arrangements for additional support needs.
That is, in effect, a no.
That is the case, but that is not a reason for not doing it. We need clarity so that we know what we are dealing with. That is the fundamental issue at the moment.
What do you see as the ideal output from such a reconvened working group with a clear code of practice on the table?
We would like clarity about the resource requirements, clarity from the code of practice and a meshing together of the memorandum with what we see as the content of the bill.
That clarity also suggests an element of financial control converging, at least to some extent, with what we have been discussing.
That must also be set in the context of all the other things that have been happening. Integrated community schools, the move towards personal learning plans and other policy initiatives will have a direct effect on the bill and on the presumption of mainstreaming.
One could at least argue in the context of community schools that there was an attempt to pilot that process through education authorities and to work out what the costs of going down that route might be before the approach was expanded across the whole spectrum. Would a similar exercise in piloting new arrangements of the kind that are proposed in the bill have offered greater certainty about how to proceed?
It might well have done—I do not know.
Pilot exercises cover all those aspects and identify additional resources or savings that could be made in the current provisions. We have used that process successfully in a number of initiatives, both in local authorities and nationally, so that could be considered.
There is perhaps also a technically linked issue with pupil records. Do you envisage significant increased costs because there will be a higher level of demand for pupil records so that people can get evidence, as they would see it, to support them in tribunal cases or for other reasons?
There is an issue right across the board in terms of the administrative costs of the proposals and the management of their administration. Who would have to provide the information that would be required for tribunals? Where some agencies are under obligation and other agencies are not, on whom will that responsibility fall?
In the context of existing local authority arrangements, that would be a significant additional task for what is, I presume, a relatively tight education administration.
Absolutely.
I would like to ask a similar question about social work. In my local authority area and in Glasgow, with which I am familiar, there is a great deal of concern about the pressure on social work resources because of children's services. In the context of the introduction of the bill—with additional support needs tribunals, processes of mediation and so on—do you envisage significant additional pressure arising out of the way in which the bill would work for what is already a hard-pressed part of the social work service?
In some senses, until you know the shape of the beast, it is difficult to quantify how hard he is going to stick his horn into you. The administrative costs of our involvement would be based on greater involvement, and that is to the good. We would expect to be called to more appeals tribunals and to be required to make more productions for parents.
In that context, is there an issue about specific groups of social workers having to spend much more time serving the system by making paperwork returns rather than by working with children?
That is a frightening aspect. I am sure that members will have heard about bureaucracy and form filling; great steps are being taken to reduce the impact of the Executive's requirements on form filling with regard to our looked-after and accommodated children. Unless there is great clarity about individualised educational programmes, CSPs and the co-ordination requirements for looked-after and accommodated children, we could end up with a massive paper chase and disagreement for years to come about which assessment holds supreme in that it covers the whole child.
I would also like to ask about mediation services. Your submissions state that you think that the cost of mediation services has been significantly underestimated by the Executive. Could you give us a rough cost of the operation of a mediation service?
Our estimate of £2 million was based on a smaller cohort of children. We are not absolutely sure whether the costs of handling requests for mediation have, as well as the costs for carrying out the process of mediation itself, been taken into account. That also brings us back to the transition issues that were raised earlier, because the whole system will be tested very hard as it is implemented. To calculate the overall cost, however, we would need to extrapolate up from the £2 million that has been estimated as the cost for the smaller cohort.
We had from one of the law centres an indication of cost, which was something like £8,000 per mediation. That gives you an idea of the cost that the local authority would be charged for the mediation.
What is the annual cost in Edinburgh of educating a child who does not have special educational needs? You must have a figure.
I can give you the figures for an individual child. The figure is £14,000 a year for a child who has special educational needs, compared with about £4,000 for a secondary-age pupil.
So the legal costs that would be associated with the tribunal would be twice the cost of educating for a year a child who has no special educational needs.
The costs per year are £4,298 for a secondary pupil and £3,181 for a primary pupil.
It is important that there are ways in which parents can engage in the process. We are not saying that the tribunals should not happen, but they need to be resourced properly so that people can have the opportunity to be part of the decision-making process about their children. That is our concern.
The tribunal does not deliver any additional services for the child; it just delivers the entitlement for the parent.
That is true. However, the theme of the bill as we understand it is to try to encourage partnership, which is a good idea. Unfortunately, it seems that the tribunals would be a little more adversarial than we would like, and that is a concern. However, it is important that we have a way in which parents can engage in the process. There will, merely because there is a change, be greater pressure on parents who are testing the system and trying to understand it.
We received a submission from Careers Scotland, which, as the witnesses know, is closely involved in the process. The submission opens with the statement:
The operative word is "might", which is the word that runs throughout what we have been saying. We want to make the bill work, but unless and until there is greater clarity, we cannot responsibly say that that can be done within this or that level of resources.
Not all children who receive support at present have a record of needs—that is not the only definition of need. The question is one of understanding what is meant for all the children who are described as having a barrier of learning. From that point onwards, progress can be made to identify which children's needs can be met by a school without the need for additional agencies to be involved and which will require the support of other agencies and—as a consequence—a co-ordinated support plan.
If I understand the situation correctly, there is concern about the lack of a definition for the children who are to get the co-ordinated support plans that are set out in the bill. There is a lack of understanding about what impact CSPs might have on other children with support needs, as their needs might continue to require to be met in the classroom. Teachers have a responsibility in that context. There is also a lack of clarity about the impact that CSPs might have on the education of all the other children who are going through the system, because of the resources that the measure might absorb.
That lack of clarity leads us to a number of possible scenarios, one of which was articulated by your colleague Mr Ewing. There are other ways of dealing with the issue. We need to get together round the table rather than deal with the process in an adversarial way.
I want to return to placing requests. The Education Committee discussed that issue, and you deal with it in your submission. I want to try to stay away from the policy issues; I simply observe that, as a result of the approach to placing requests that has been taken, there is likely to be a higher demand for access to pupil's records. Do you have a view on how much that might cost?
I am not sure that we have a specific answer to that question, but we can give the committee an indication of our present experience.
We are very concerned that, given all the uncertainties about definitions and so on, an authority might find itself with an increased demand for placing requests for independent schools. Indeed, we are concerned that facilities in some existing independent schools may well fit the definition of a special school that is contained in the bill. Parents who currently choose to educate their children in the independent sector will be looking to their local authority to pick up the costs—or some of the costs—of those placements. That would place a significant additional burden on the local authority.
I also have a question for the representatives of the Scottish NHS Confederation.
I will bring them in afterwards.
I return to the Careers Scotland submission, which contains another worrying point, in addition to the one that Fergus Ewing referred to earlier. It says that the 20 per cent figure
That depends on the issue that requires additional support. If we are talking about a health issue that affects the child's ability to engage with their education, one can say that, as the position may not change, the money will have to be spent all the way through the child's education. If we are talking about a social issue, such as compulsive behaviour disorder, which we dealt with earlier, one can say that that will not be an issue further down the line.
In your own gamut of inputs, you do not refer to international models or benchmarks that illustrate how outcomes such as the 20 per cent level have been avoided.
To be honest, we have not looked at the issue from that perspective. On one level, the question of additional support is not a great cause of concern. Under the existing legislation, it is estimated that up to 20 per cent—in fact, I think that it is up to 25 per cent—of children and young people may have special educational needs.
Do we have any methods for benchmarking the level of special needs or the requirement for additional support in order to compare Scotland with other regions of the United Kingdom and internationally?
That might be a question that we could flash at the Executive when its representatives are in front of us; it is probably not a question for COSLA.
I had not intended to make an opening statement because I expected that the committee would have our written submission.
We have it.
It might be helpful if I just summarise the submission's key points for the committee.
I will raise the staffing issue, which was mentioned in the Education Committee's meeting last week. I want to find out whether you have anything to add in the financial context on the implications for staffing levels and staff training, particularly in the areas of speech and language therapy, physiotherapy and occupational therapy, which are likely to be called into play more extensively as a result of the co-ordinated support plans.
Since we appeared before the Education Committee last week, we have been discussing the issue with our members and trying to get some more detail. Our present best estimate is that, throughout Scotland, we would probably need about an additional 60 therapists in each of the three categories of therapy. It is hard to know how that will translate into cost, because there will be a number of variations to do with grades and the additional expenses that go with an individual's discharging of their duties. Our estimate is that that would cost roughly £2.4 million across Scotland. We need to do further work on that estimate, to test how accurate it is.
Thank you; that was helpful.
I want to consider matters in the context of the NHS contribution to linking in with schools. There is obviously a significant public health agenda, with information going into schools. Do you think that the bill's more targeted intervention is being set against public health intervention? Given that we always have limited resources, is the bill forcing us into a choice between different kinds of intervention? Has there been any cost-benefit analysis of the wider interventions compared with the more focused interventions?
We would certainly hope that it is not an either/or situation. As you say, with the best will in the world, we must acknowledge that the available resources are finite and that some prioritisation might be necessary. We would like the health service's existing work with schools to complement the work on co-ordinated support plans, which will probably involve different therapists and different groups of children. My colleague might have something to add on that.
On joint working between health and education, we would like structures to be implemented that replicate the existing joint structures between health and social work; perhaps more appropriately, we would like education to be brought into those structures, because it is clear that there are links between all three areas. We hope that, where existing work is going on—for example, in public health and health improvement—the planning in those areas will be improved and enhanced by joint working. We also hope that there will not have to be a play-off between specific interventions and on-going health improvement work, but that all joint working between the health and education sectors can be better planned at a higher level.
My concern is about whether the driver in relation to resources will be the needs of children with identified additional support needs or whether it will be based on an overall appraisal of the health requirements of all children in school, including children with additional support needs. It is a question of where one starts from when one thinks about how to manage and allocate one's resources.
In health care generally, not just in health care for children, the reality is that the driver is the delivery of health care and health services, rather than health improvement. Everyone has acknowledged that the balance of those priorities has to change but, in reality, the driver for all services is the delivery of special services to people who need specific health care interventions and I am sure that—in the first instance at least—that will also be the case for the services that are covered by the bill.
You say that we have all got to realise that we should move towards the health improvement agenda, but you also say that the provisions in the bill might drive you away from that; or rather, that the mechanisms for the allocation of resources that are envisaged in the bill might drive you towards a service mechanism.
That will not necessarily be the outcome. The Finance Committee is obviously focused on specific resources, and our focus is on the specific resources that will be required to deliver services. I do not think that we have really considered the health improvement implications. As you have raised the issue, I do not think that what you have suggested would automatically be the outcome. In the first instance, the NHS's job will be to examine future unmet need and to plan and deliver for that. I suppose that what you say is correct, in that the bill will focus priorities on that in the first instance.
In your submission, you suggest that you expect that the number of children who have a co-ordinated support plan will be greater than the number of children who currently have a record of needs and you point out that there are a number of children who do not qualify for a record of needs but who, under the bill, will require medical intervention. I presume that you feel that the figure of £915,000 that is allocated to co-ordinated support plans is insufficient. I presume that those children already have a medical intervention.
They may not. Our interpretation is that the bill will extend the support that is available to children who have, for example, social, emotional and behavioural difficulties. There is an increasing awareness that, at times, those problems may have a physical cause that has not thus far been recognised. Our interpretation is that those children will be included in the new system and that they could be recognised as benefiting from some input from the health service. The figures that appear in the table do not appear to reflect the fact that there may be other groups that have not yet been identified.
Is it possible for you to give an estimate of the number of young people that you are talking about?
We have not been able to do that so far. We heard earlier about pilot schemes, and it might be that a pilot scheme would help to identify the scope of that.
But you expect there to be a greater demand.
Yes.
Because there is unmet need in the system at the moment, which will be required to be met under the bill.
We recognise the fact that there is unmet need, as is evidenced in the waiting times for existing therapies, although that is probably more a reflection of the small number of therapists in those professions. Additionally, we expect the bill to identify a new group of children who are not currently recognised as needing help but who will come through the system and will, subsequently, be recognised as benefiting from some of those therapies.
I spoke to the head of a paediatric therapy department, who estimated that, out of the cohort of children with social, emotional and behavioural difficulties who will be brought in under the bill, up to 50 per cent might have undiagnosed physiological or physical needs that are currently not being met. However, as awareness of their needs increases in the education sector, as joint working increases, more and more of those children will be identified and there will be a greater awareness among teachers of the fact that behavioural difficulties may stem from, for example, an undiagnosed autistic spectrum disorder. Once such conditions are diagnosed, therapy and mental health services will have a role to play that they are not playing in those children's lives at the moment.
We asked COSLA about the consultation that led to the drawing up of the financial memorandum. Martin Vallely said that there were two health sessions for the working group. Did the confederation take part in those?
No, but members of the confederation—individual health organisations—were involved.
Can you talk about the quality of that consultation? We have heard that not all COSLA's views were taken on board by the Executive. Did you have a similar experience?
I cannot answer in any detail, as it was not the confederation that was involved. However, the feedback that we have received from those of our members who were involved has not focused on the figures that have appeared in the financial memorandum, which I understand are higher than those in the initial drafts. That may reflect some acceptance of the points that were raised. What has been raised with us is the question of the unmet need in the existing system and the potential for greater needs coming through. The concern has been not so much about the figures that are in the financial memorandum as about what may have been missed or excluded.
Do you know whether there was an equivalent trawl of the local authorities that Donald Thomas talked about in trying to gather data?
I am not sure. I know that three specific organisations were involved, but I do not know whether there was a more general trawl. There may well have been one, but I cannot say for certain. I would be happy to check for you.
That would be helpful. When we have the Scottish Executive before us, that would help us with our questioning.
Your submission talks about the burden of additional costs falling particularly on speech and language therapy, physiotherapy and occupational therapy provision. Is there any plan to assess and address the issue of nutrition as a potential mechanism for alleviating the problems of individual children?
I am sure that that is one of the issues that is assessed. We have concentrated on those three therapies because they tend to be the main ones that are involved. Nevertheless, a whole host of other interventions will be considered when a child is assessed.
Yes. I am quite sure that dietetics will also have a role to play. Exactly the same issues that apply to speech and language therapy, physiotherapy and occupational therapy apply to dietetics, which is also a small profession with a limited capacity. There is a possibility that, as awareness grows of nutritional issues in relation to autistic spectrum disorders, dietetics will become another profession with additional work arising from the bill, and it will be stretched in its capacity to undertake that work.
Are there no thoughts of doing anything generically and proactively with the schools to alleviate the end burden on the therapies, which would make for a virtuous circle regarding the overall burden?
That is the point that I was trying to make about health improvement and where there is a trade-off between a focused, targeted approach and a generic approach that might hit a wider number of children. Both approaches are necessary; it is just a question of how the finances are managed between the two.
It is our view that specifically targeted work has to be carried out across the therapy professions in a multi-agency way. Work-force planning and development structures have been put in place in NHS Scotland's new regional work-force groups. There is also NHS Education for Scotland, and other mechanisms are in place to consider the sizes of professions, their capacity and recruitment and retention. As we said in our evidence to the Education Committee, those mechanisms will have to focus quite urgently on the capacity and work-force planning of the therapy and allied health professions, taking into account the new responsibilities that will exist throughout health services as a whole.
You obviously disagree with the financial memorandum working group's view that the costs of what is suggested will be negligible. This is an observation rather than a question, but you might like to respond to it. Whenever there appears to be a way of saving money in bills, there are always a lot of good reasons—and I am sure that your reasons are as good as anybody else's reasons—why that will not be possible. I offer this as a thought on health in general. We continually read that, despite the money that we throw at health, it is not going in the right direction or being targeted in the right areas. Have you taken that into account in coming to your assessment of the requirement for various extra speech therapists, occupational therapists and others? Have you factored them into the equation without really knowing what the eventual equation is going to require?
We would accept that as a fair comment. Specifically on the savings that the financial memorandum identifies, our concern is that, although the reason for the savings identified centres on the removal of the element of compulsion from medical assessments, which seems perfectly reasonable, in reality we know that it is quite often difficult to get that amount of money out to spend on something else because the people who would be doing the assessments will have other responsibilities that they will then spend more time on. It is not a simple case of a member of staff or two members of staff no longer being required and the money that would have paid for them being made available for something else.
I thank you all for coming along and giving evidence. We are taking evidence from the Executive in a fortnight's time, so we will have an opportunity to reflect on all that you have said to us and to prepare appropriate questions for Executive witnesses.