“Better equipped to care?”
I welcome back the press and the public to the sixth meeting of the Audit Committee in 2004 and remind everyone to turn off their mobile phones and pagers.
Agenda item 3 is consideration of Audit Scotland's report "Better equipped to care? Follow-up report on managing medical equipment". I invite the Auditor General for Scotland to brief the committee on the report.
Mr Robert Black (Auditor General for Scotland):
Thank you, convener. I invite Caroline Gardner, who is the deputy auditor general, to brief the committee.
Caroline Gardner (Audit Scotland):
I will give a brief introduction to the report.
The report follows a baseline report that the Auditor General published in 2001, which made a number of recommendations aimed at improving the management of medical equipment. The area is important for two reasons. First, medical equipment is critical to the care of most patients in the national health service and, secondly, a lot of money is tied up in it. We estimate that the value of medical equipment in the NHS at the moment is more than £600 million and that around £130 million a year is spent on replacing and maintaining equipment. Therefore, the issue matters to the NHS in many ways.
The follow-up report addresses the areas of concern that we identified back in 2001. We think that there is still substantial room for improvement throughout the NHS in Scotland in respect of how medical equipment is dealt with. There are three main areas in which there could be improvement. First, medical equipment needs to be given a higher profile. NHS operating divisions must have a clearer picture of what information they currently have, including the age of equipment. They need to plan for its replacement and keep an eye on developments that might mean that better equipment is available to improve the care that patients receive.
To ensure that that happens on the ground, we think that there is a case for the Scottish Executive Health Department to take a clearer lead on medical equipment. In the report, we have recommended that the department might consider putting in place a specific standard for managing medical equipment within the controls assurance statement that health boards are required to complete each year. That would provide assurances that proper management arrangements are in place to manage the risks relating to equipment.
Secondly, we think that more could be done to manage the risks relating to operator error in using medical equipment. We found that only half of the trusts that we looked at had comprehensive systems for planning and recording staff training. Of course, that does not necessarily mean that staff are not being trained, but it means that there are risks in respect of managing the risks relating to equipment and ensuring that staff are properly placed to use the equipment that they need to use.
Finally, we think that there is a risk related to over-reliance on aging equipment. Such equipment might work well at the moment, but the risk that it will need to be replaced quickly increases with the equipment's age. That risks service continuity—being able to deliver services as planned—and financial problems, if planning for replacing the equipment has not been done. In the 15 categories of equipment that we considered, a quarter of the equipment was beyond its standard life at the time of the audit.
Those are the three areas in which we think that there is room for improvement. We will be more than happy to answer any questions that members have about medical equipment or the report. As I said, the report is a follow-up report and the areas that I have mentioned are the continuing areas of weakness in which we think that there is room for improvement.
Thank you for that briefing. The committee will discuss its response to the report under agenda item 7, but we have an opportunity now in public to ask Caroline Gardner any questions or for any clarifications. Do members want to raise any issues?
Some equipment in hospitals is provided by donation. It would be interesting to find out how many pieces of equipment in Scotland were provided by donation, what proportion of the total amount of equipment that represents and about the planning process that is involved. I know that some gifts are well intentioned, but they might be a gift of a particular piece of equipment and a replacement for something older or more prone to breakdown might have been better. Was that matter considered?
You are quite right. Donated equipment can be a difficult issue for the reasons that you have given and because the purchase costs are often covered, but not the maintenance costs thereafter. I am not sure how closely we considered the area—I will check with the team behind me.
I will say something about that, as I was speaking to the team when Caroline Gardner was speaking. Rhona Jack has reminded me that we mentioned the matter in the first report, but did not follow it up in the report that we are discussing, because donated items are a very small part of the stock of medical equipment.
I would like to pick up from where Margaret Jamieson left off. In the past, there have been contentious and well-publicised cases of local fundraising for particular pieces of equipment that local health services said they did not want or need as a priority and for which there was no money for maintenance. There is an interesting issue about the degree of planning that we ought to expect from the service at a local or national level. Would you like to elaborate on that? In simpler—or even simplistic—terms, it is sometimes suggested that there should be a national planned replacement list, which is dealt with year on year. Will you give us more of a sense of the level at which you think such detailed planning should take place and whether an explicit, itemised list ought to exist? Should such planning be a more integral part of working year on year?
You said that 15 different categories of equipment are covered in the report, but is there a distinction in the planning approaches for different types of equipment? No one would advocate having people sitting in St Andrew's House planning where every X-ray machine in the country should go. However, there are interesting debates to be had about some of the bigger items of equipment, such as magnetic resonance imaging scanners, which are used on a more regional basis.
I will start by dealing with the last question and will then work backwards.
We distinguished between two broad categories of equipment: high-value, low-volume pieces of equipment that need very long-term planning, probably on a national basis; and low-value, high-volume pieces such as infusion kits that are on every ward and are used every day, planning for which is likely to be managed much better at local level. We were concerned that such planning in NHS boards tends to be managed too far down in the organisation, so that in many cases it is not visible to the board as part of its strategic planning for delivering future health care. The records and information that are available at operational level are not really good enough to support planning and management. We are not suggesting that there should be a list in St Andrew's House that indicates when every infusion kit should be replaced. However, if the question is asked, information about how the process is managed should be readily available to the health boards and the department.
Understandably, the Health Department would argue that its focus is on high-value pieces of equipment and those that are related to service change. For example, it thinks about the provision of new cancer services as part of the cancer strategy. That approach is absolutely necessary. However, we are concerned that insufficient attention is being paid to more everyday pieces of equipment that still account for a great deal of money and involvement in patient care. The information is not available to ensure that provision of such equipment is being planned and managed as effectively as it could be. We are not saying that equipment is not being managed effectively in all cases, but people do not have readily available the information about what they have, what they are spending and how old equipment is that would assure us that the system is working well in practice and that we should leave well enough alone.
When faced with clinical negligence claims, surely it would be to the benefit of the NHS if it could demonstrate that there was planned maintenance, renewal and so on. A significant amount of money is going into the pot to defend the NHS against such claims. Did you consider that issue?
We have not examined directly the number of clinical negligence claims that arise from problems with the use or availability of medical equipment. However, the member is absolutely right—all the research that has been done suggests that such problems are a significant source of negligence claims. That is why we are suggesting that this issue should be included in the controls assurance statements that health boards have to make each year, to ensure that the matter gets the right attention at national level and to enable health boards to demonstrate that they are doing the right things day by day.
We could include it as a tick box in the performance assessment framework.
We did not recommend that.
As there are no further questions, I thank Caroline Gardner for her briefing. We will discuss the matter further under agenda item 7.