Committee
Audit Committee, 23 Jan 2007
23 Jan 2007 · S2 · Audit Committee
Item of business
“Implementing the NHS consultant contract in Scotland”
As well as there being a high number of instances of "Noted", there is also a mixture of "Not agreed" and "Disagree". To me, those alternative wordings indicate that a number of different people have compiled the response.I have a comment on the future of the consultant contract, which was covered in paragraph 84 of our report. We said that the"wider service benefits from the considerable investment in the consultant contract are not being demonstrated."The response to that is given in the form of appendix A. I will not go through every single detail, but I draw members' attention to the first page, where the department indicates that the consultant contracts have been used in Dumfries and Galloway "to increase use of Laparoscopic surgery".The department goes on to mention"Use of the consultants contract being made to revise labour ward on call sessions"and a"Reduction in number of limited value operations".I do not know what that means—perhaps we could get clarification. The response goes on to say that "theatre utilisation rates" have been agreed using the contract. When I was with the health service, such things were on-going and it did not require a truckload of cash for individuals to change how they worked.Further down the page, other areas are mentioned. Highland NHS Board"permitted opening of an additional theatre"and identified areas where patient needs can be met by general practitioners with special interests, and in radiology it aims"to reduce waiting times for diagnostic services."Grampian NHS Board"has identified areas where other practitioners can carry out work"and is engaged in service redesign.This is not rocket science. Those reforms are part and parcel of change that has been generated from within. Other professions in the health service did not get a truck load of cash to get them to change. I would have expected a developing service to be making such changes automatically and I am disgusted with that response.
In the same item of business
The Convener:
Ind
Item 4 is a response from the Health Department, in the name of Kevin Woods, to our report on the consultant contract. I invite members to comment before Aud...
Robin Harper:
Green
Towards the end of the response, Mr Woods admits to contract mistakes. However, he says that patients have benefited from reforms and he highlights the move ...
Margaret Jamieson:
Lab
That raises a question. The difficulty is that the contract does not talk about outcomes. Perhaps that is a problem that some of us feel should have been ove...
Mr Welsh:
SNP
Page 13 of the response quotes from our report, which states:"The Committee is of the view that current monitoring arrangements are not sufficient, particula...
The Convener:
Ind
Anything from other members?
Margaret Jamieson:
Lab
If I may just get to this; I am not going to go through—
The Convener:
Ind
If I may first make a more general point, I am concerned about the extent to which many of the responses from the Health Department start with "Noted", rathe...
Margaret Jamieson:
Lab
As well as there being a high number of instances of "Noted", there is also a mixture of "Not agreed" and "Disagree". To me, those alternative wordings indic...
The Convener:
Ind
It has already been drawn to my attention that the response mentions changes that might have been achieved anyway.
Margaret Jamieson:
Lab
Other health boards did it.
Susan Deacon (Edinburgh East and Musselburgh) (Lab):
Lab
I have some sympathy with the comments that Margaret Jamieson just made. Although I accept that many of the examples of good practice that are listed have be...
The Convener:
Ind
It is irritating that, with many of the issues on which the response is "Noted", when one reads what the department says, it is clear that it should have sai...
Margaret Smith (Edinburgh West) (LD):
LD
I will pick up on two issues. Now that we have done the work and received the response, the question is whether, at a gut level, we honestly feel that there ...
The Convener:
Ind
I draw your attention to paragraph 81, on the pay structure, and paragraph 84, on the future of the contract, where we mention aspects of evidence. We are ju...
Mr Welsh:
SNP
We are touching on matters that are fundamental to the work of the Parliament. We are talking about the accuracy and applicability of the data and informatio...
The Convener:
Ind
There are seven areas in which the department agrees with us. Members are free to comment on those as well.
Margaret Jamieson:
Lab
Andrew Welsh commented on the accuracy of data. Forgive me for focusing on the Executive's comment on the health board in my area but, under the heading "NHS...
Mrs Mary Mulligan (Linlithgow) (Lab):
Lab
I agree with many of the points that have been made. I will not repeat them. I am a little concerned that the Health Department seems to be justifying the co...
The Convener:
Ind
That is because it has stepped aside from the target.
Mrs Mulligan:
Lab
Yes. Although the detailed response that is provided about advertising and follow-ups is fine as far as it goes, I would have expected something in it about ...
The Convener:
Ind
It is noted that the Executive's answer to our recommendation in paragraph 81 is that it stepped aside from a target of 600 and achieved an increase of 389.
Susan Deacon:
Lab
Notwithstanding the comments and criticisms that we have all made, it is important for us to make wider comments and not to lose sight of the big picture. Th...
Robin Harper:
Green
A theme that has run through all our comments is that there is a lack of willingness to get to grips with the problems. I want to go back to Margaret Jamieso...
The Convener:
Ind
I invite Caroline Gardner to respond on behalf of Audit Scotland.
Caroline Gardner:
Two broad points are worth making. On the issue of looking ahead and learning lessons from the consultant contract, we are pleased about the acknowledgement ...
The Convener:
Ind
Now that we have all commented, the next question is how we respond to the department's response. Obviously, we could draft a letter to raise a number of poi...
Mr Welsh:
SNP
At the very least, I would like a response to the comments that have been made about how the committee's reports have been reacted to. I believe that they ha...
Mrs Mulligan:
Lab
It is important to ensure that the Health Department is aware of our concerns about the response. We should note both the points where the response has been ...
The Convener:
Ind
Is the committee agreed that I should write to Dr Woods in the strongest possible terms? Also, given what Andrew Welsh has said about the broader issue of ho...
Margaret Smith:
LD
I have a small point to make on the back of what Mary Mulligan said, which I totally agree with. There is a terrible temptation, at this point, to fling ever...