Committee
Audit Committee, 06 Jan 2004
06 Jan 2004 · S2 · Audit Committee
Item of business
“Overview of the National Health Service in Scotland 2002/03”
Mr Black:
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I will be pleased to do that; I believe that that is an extremely important issue.The report identifies some of the in-year developments that take place in order to allow the health system at board level to report financial balance. A recurrent experience is that pressure within financial years tends to come on acute trusts. That seems to be a feature in all parts of Scotland. There must be a possibility, therefore, that in-year pressures on acute trusts will continue in future years. Budgets will have to be reallocated from primary care and community care activity in order to bring the whole system into balance. The Health Department will have dictated its strategic priorities for the health service as a whole and, in turn, health boards will have set budgets to accord with their own priorities. It strikes me that there is a possibility that a recurring feature will be that the money is not actually spent where it was intended to be spent. I imagine that that would be of continuing concern to the committee. That is one possible risk that exists.Another risk that exists is that the provider units will not have clear incentives to manage their budgets well. If I were managing an acute directorate budget and got into the habit of depending on funding's being transferred from other parts of the NHS system each year, perhaps I would have a less clear incentive to manage within the budget than if there were transparent financial reporting on my budget.My final point relates to the role of the committee: if the financial reporting deals with, say, only the overall financial performance of an NHS board, where the bottom line is that the board has achieved financial balance, that means that the committee could comment only at a very high level on what is happening within the health service. The committee would not therefore have been in a position to scrutinise terribly effectively what was happening to, for example, the £748 million of public funds that Lothian NHS Board that were spent in the financial year in question.For all those reasons, it is important that we encourage the Scottish Executive Health Department to expect health boards to report in a transparent and consistent way the moneys that are spent on the acute sector, on primary care and on joint resourcing.
In the same item of business
The Convener:
Con
Item 2 is a briefing from the Auditor General for Scotland on the report, "Overview of the National Health Service in Scotland 2002/03". I invite the Auditor...
Mr Robert Black (Auditor General for Scotland):
Thank you. I, too, take the opportunity to wish everyone a happy new year.I welcome the chance briefly to introduce the report, which provides an overview of...
The Convener:
Con
Members will be aware that, under agenda item 7, we can discuss how we might respond to the report, but there is ample opportunity to ask questions of the Au...
Margaret Jamieson (Kilmarnock and Loudoun) (Lab):
Lab
I want to ask about the Common Services Agency. The CSA caused some concern to the previous Audit Committee, which took evidence on qualification of primary ...
Mr Black:
I will turn to my team to ask whether they can provide an answer to the question about the detail of the position in Dumfries and Galloway.
Graeme Greenhill (Audit Scotland):
The question is largely one of patient confidentiality. The requirement was to write to patients who were identified as having received treatment, but I thin...
Margaret Jamieson:
Lab
That leads to another question about why we cannot be assured that proper claims are being made. There are GPs throughout each of the health board areas, yet...
Mr Black:
We would not wish to mislead the committee, so the committee may have to take up that issue with the Health Department. We also have to reflect on the possib...
George Lyon (Argyll and Bute) (LD):
LD
One issue that is highlighted in the report is that, by amalgamating the trusts into single-tier boards, we might lose transparency about where deficits or l...
Mr Black:
I will be pleased to do that; I believe that that is an extremely important issue.The report identifies some of the in-year developments that take place in o...
George Lyon:
LD
You said that it is always the acute sector that seems to lose control of the budget during the year. What are the underlying reasons for that? Is it because...
Mr Black:
It is fair to acknowledge that the challenges of managing the budgets in the acute sector are particularly intense. Committee members will be well aware of w...
George Lyon:
LD
Paragraph 3.31 of the report states:"SEHD does not know the cost of implementation of New Deal".That is a staggering statement in an Auditor General's report...
Mr Black:
It goes without saying that the department is best placed to answer that challenge. However, I invite Caroline Gardner to give a sense of our understanding o...
Caroline Gardner (Audit Scotland):
Both the new deal and the new general medical services contract are United Kingdom-wide agreements that are being implemented in Scotland. I know that the He...
George Lyon:
LD
That raises the question of how we meet ministerial targets.
Caroline Gardner:
Yes. We must accept that budgeting in the health service is complex. To a great extent, the service is demand led and responds to emergency or urgent pressur...
Susan Deacon (Edinburgh East and Musselburgh) (Lab):
Lab
I give notice that, if time permits, I would like to ask a couple of questions specifically about Lothian NHS Board. For now, I will restrict my questions to...
Mr Black:
We are working on a report that considers the performance management and reporting systems in the health service, which will be published before too long. Wh...
Susan Deacon:
Lab
I am grateful for that answer.The second issue about which I want to ask is the on-going process of integration of decision making. Again, I am pleased to he...
Mr Black:
The short answer to that question is that it is too early to provide evidence that the new arrangements are achieving benefits. The process of integration is...
Susan Deacon:
Lab
I want to pursue the subject of integration and to pick up George Lyon's line of questioning about transparency and your concerns that there is a risk that t...
Mr Black:
At this early stage, the only comment that I can offer is to encourage the department and health boards to ensure that they report in a transparent way, so t...
Susan Deacon:
Lab
My final question relates to the working time directive. I ask you to share with us your overview of the wider impact of the working time directive on the pu...
Mr Black:
I am sorry, but I doubt whether we have such information at hand. Perhaps one of my colleagues feels sufficiently in tune with what is happening in other par...
Caroline Gardner:
Bearing in mind Bob Black's caveat, I will hazard a comment, which will be no more than that.We have kept an eye on the working time directive and it is obvi...
The Convener:
Con
That is helpful.
Robin Harper (Lothians) (Green):
Green
I want to check that I understand the terminology correctly. Paragraph 29 of the report mentions "cash releasing efficiency plans". I presume that that means...
Mr Black:
The phrase means initiatives that have been identified that will allow money to be released for redeployment to other activities or to help with a deficit wi...
The Convener:
Con
If members have no further questions, Susan Deacon may ask about Lothian.