Chamber and committees

Well, I now have two things to say.

First, however, I turn to Professor Needham. You talked about how, in England, there was the sense that the larger for-profit organisations were surviving the financial climate, but the not-for-profit sector was more at risk of having to close services, although their inspections showed better returns. You said that, with children’s services in Wales, it has basically been decided not to procure from the for-profit sector. Will you say a bit more about that? I would then like to come back on the money point, convener.

Presumably, that information would allow you to track people who attend a class, such as the wheelchair yoga class in Dundee for people who have diabetes and have had amputations, and compare them with other folk within their cohort who do not go to the class. That would evidence a definite correlation with savings.

We have talked about budgets and percentages, and the other thing that we want to ask witnesses about is the best age range at which to intervene. The Scottish Government is talking about providing heart and lung MOTs with Chest Heart & Stroke Scotland, and we are talking about sending Christina cards, so that when women get to 50, they receive advice about what they should be doing. What are your views on the age range at which interventions would have the biggest impact? We know that health spending is high at the beginning of life, but then it starts going up at ages 60 and 70 and goes through the roof at 90. If we are trying to manage the budget to prevent that hockey-stick graph, where should we put our efforts in terms of working with the Scottish population to stop them needing more acute care?

I am just going to report Jack to the parky—or the municipal police.

Forbes Dunlop, the last time that you were here—and again today—you made a very strong case for the role of sport in prevention, and you mentioned the figure of, I think, 3,000 preventable deaths. I wonder whether you can help the committee to get a better handle on that. We talked earlier about identifying preventative activity and quantifying its impact, and I know that, for many of your organisations, there is a tension between the pressure to produce elite athletes and the need to provide, say, a stroke exercise class. Indeed, we have heard a really good example from Aberdeen in relation to swimming. What can you do in your portfolios to demonstrate that an activity is definitely preventative, and how might that link to social prescribing? I am not sure how the model works, but I think that there is definitely a pathway there.

I would like to hear from each panel member on that.

11:30

Thank you for all your work on that report, Professor Feeley. It was widely accepted and acknowledged as very good work five years ago.

As you know, the previous Administration aimed to implement those principles, but, unfortunately, we did not get there. You did a lot of work on trying to evaluate unmet need, but you were agnostic about governance and leadership in social care, because that issue was not under debate at that time. We know that it is a very cluttered landscape. Sixty-seven per cent of NHS board money, and 29 per cent of local authority money, goes into integration joint boards, which deal with social care.

Given the current proposals to streamline the health boards so that there are just two of them and to redesign local authorities, what is your thinking about what we need to protect in the existing system to ensure that social care is still a priority? I also want to ask about an issue that Professor Catherine Needham has raised elsewhere, which is what percentage of funding we need to shift towards social care for it to begin to function in the way that it should.

So, my question is about governance structures in the new world and about percentage transfers.

If you were in that position—

Thank you. That is about values and principles and how you manage the market so that it might transform into a different space.

I will come back to the earlier question about money. This evidence session is about pre-budget scrutiny, so the committee’s job is to look at the lines in the Scottish Government budget and try to make sense of whether we are moving towards prevention.

In a previous meeting, we heard evidence from Linda Bauld that Australia committed 5 per cent of the budget over five years to make a shift towards prevention. It goes back to the scale of the challenge that we face and how we identify money to enable the transition to happen. We have set up a just transition fund to move from oil and gas, and 30 years ago—because I am very old—we closed the long-stay institutions. There was a massive values-led change in how we looked after people with learning difficulties. We got thousands of people out of long-stay institutions and moved them to receiving support in their homes. That was funded.

How do we earmark, ring fence or identify money to enable that transition to happen? Do we call it something else, such as capital investment, because it is about changing outcomes over 20 years, not a year? How could we look at that budget line creatively and say, for example, “Cabinet secretary, we need 3 per cent more to move across”?

Do you have any evidence that you are broadening the impact? If so, what evidence do you have?

Alastair Evans: We can see that, over a longer period, we are marginally bringing down some of the barriers in relation to the Scottish index of multiple deprivation. I think that all public bodies struggle with really getting into communities where there are a range of persistent issues relating to deprivation. Beyond that, however, we are covering all the bases across Scotland. We do not now have huge variations in levels of attendance and participation by geography, although we know that groups from different backgrounds and different socioeconomic groups have different ways of interacting and they might not be doing so at the same level.

In summary, there is some movement. It is difficult to chart it in detail, but multiyear funding is an aspect of that. A number of community organisations are coming into the portfolio, getting funded and providing arts and culture to their communities, but there is more work to do. I think that any public body would say that to the committee. It would be complacent to say that there is not more work to be done to reach everyone in Scotland.

I very much welcome the fact that it is such a conscious ambition and you are really working to achieve that.

Has the frameworks of impact work now gone out to tender? What is the timescale for that?

Alastair Evans: It is now out there, and we will be working through that over the next six months. We want to engage with some of the new thinking that is out there about not just focusing on economic impact but trying to build social and cultural impacts into some of the models.

It is not purely about gross value added, jobs or turnover. Those measures are important and we will continue to work with them, but that will be in order to understand the linkages between the health of the economy and wider social and cultural health. That is also core to the Government’s ideas on the wellbeing economy and the way in which it is seeking to refresh the national performance framework to focus much more on a holistic notion of wellbeing. We want our work to align with that focus, and we want to bring in the best thinking that we can to help us to do that.

10:15

I assume, then, that you will be making organisations aware if they are not doing as well as they should be.