Committee
Audit Committee, 23 Jan 2007
23 Jan 2007 · S2 · Audit Committee
Item of business
“Implementing the NHS consultant contract in Scotland”
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 been brought about by the new contract—in other words, the contract has been used to lever those changes—many groups within the health service and other sectors could reasonably ask why it required such a substantial and costly change in terms and conditions for that staff group to bring about changes and improvements in practice that are, in some cases, quite marginal. That remains one of the big, overarching questions about the reform.On whether the Health Department has classified recommendations as "Noted", "Agreed" or "Disagree", the number of times that a recommendation is "Noted" registered with me too. I am intrigued by the frequent use of that non-committal term and am not sure how to interpret it, to be honest. However, it leapt out at me how few of our recommendations were disagreed with. That is very striking. We should welcome the fact that some of the shortcomings of the process have been acknowledged explicitly—more so in some cases than others—and that some indication has been given of improvements that will be made in future, such as the drawing up of a clear protocol for any United Kingdom-wide negotiations. It is unfortunate that two of the biggest reforms—the consultant contract and the GP contract—have already been done but, nonetheless, the changes that have been made to the process should be noted.One point caused me particular concern because of what it tells us about what the NHS in Scotland has signed up for. In paragraph 20 of our report, we commented that we were not persuaded that the contract fully takes into account"the differing characteristics of and challenges facing the service in Scotland such as; higher staffing levels; greater remoteness and a smaller independent health care sector."The department noted that comment and I note that its response says:"The size of Scotland's staffing levels and independent health care sector could not compromise the requirement to agree consistent levels of pay and working hours across the UK, without which the profession would have refused to agree a contract."That strikes me as a tacit acknowledgement—if not, indeed, an explicit one—that Scotland paid over the odds for the contract. Although it has been widely accepted by the committee, the Executive and the staff representative bodies that it remains in the best interests of the NHS in Scotland—and elsewhere in the UK—to have UK-wide contracts, the department's comment raises a question about the extent to which, despite all the rhetoric to the contrary, there was any willingness on either side of the negotiating table to take meaningful account of Scottish needs. It is a particularly telling remark.
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...