Chamber and committees

I will bring in Richard McCallum to talk about our work with boards on how we can share learning.

We have a formal process for monitoring all our boards’ performance, not just in terms of key targets but around financial management. We also conduct an annual review process for each of our boards to evaluate the progress that they are making; they have an in-year review as well.

One challenge that has been around for a long time—I recall this from when I was previously a junior health minister—is trying to make sure that, where there is good practice in one part of the country, it is replicated in other parts of the country. That challenge is not peculiar to health; it is a challenge within the public sector overall. It is always a source of frustration to me that, in a country of 5 million people, we struggle at times to make sure that good practice is replicated and that where it is established, it sticks.

We have a number of different mechanisms through which we seek to do that. One is that we regularly bring our board chief executives together to focus on particular areas of challenge and, where they have taken new approaches, to share that practice. We do the exact same thing with the NHS chairs of the boards. I meet them every six weeks or so; we have the opportunity to focus on key areas where there is good practice or on areas where there are challenges, in order to try to encourage good practice.

We are also making much greater use of the centre for sustainable delivery, which is based at the Golden Jubilee National Hospital special NHS board. The centre was established to look at key areas where there are opportunities for efficiencies and improvement in service delivery. It takes that forward with individual boards and it can model what the impact would be on an individual board if it were to deliver something differently. It can also do specific work with individual boards.

Over the next couple of years, the centre will probably be the key mechanism that we will use to try to get greater consistency, to make sure that we are getting better adoption of good practice where it has been identified, and to bring new ideas to boards.

I will ask Richard McCallum to say more about what we do on finance with the boards.

We are taking forward a range of work to encourage the adoption of good practice where it has been established in one board.

I understand the concern. I will ask Nigel Robinson to say a wee bit more about the practical application of the process and how the GMC might address some of these issues.

We are looking for the national board to take forward that work. I will let Scott Wood say a bit more about that, but we need to ensure that there is a consistent approach.

By and large, we do not get a Barnett consequential for social care. There is no direct Barnett consequential for that in the way in which there is for health.

There are a couple of different routes through which money flows into social care. We provide funding to local authorities. Some health boards will invest in social care provision alongside some of the central funding that we provide for social care. That is largely for things such as pay uplifts. The scale of financial demand in health is markedly different from that of social care. Obviously, healthcare gets the lion’s share of the funding. We have made a deliberate decision to ensure that we increase investment in social care, particularly in staff, in order to increase or sustain the capacity of the service, because we know that it is under significant pressure.

One of the things that it will be absolutely essential to deliver as part of our reform programme is a national care service through which we can ensure that there is a greater consistency of approach to the provision of social care and that that aligns with the NHS much more effectively. We can see variation across the country, and that impacts on how social care services are received by individuals who require social care support and on the performance of the NHS.

Going forward, we will need to see even further investment in social care, and we will also need to see service reform. A national care service is going to be critical to ensuring a much more consistent approach to how social care is delivered and provided in the country, and one that aligns much more effectively with the NHS and helps to support it. Further investment and service reform are going to be critical.

That is a legitimate concern to raise. As I mentioned to Dr Gulhane, we are taking a measured and evidence-based approach to the use of PAs and AAs and where those will sit in NHS Scotland and our workforce development. Scott Wood can say a wee bit more about that, because it is important that we ensure that the important training environment for our junior doctors is not compromised. However, I believe that it can all be managed in a proper programmed way, with a clear sense of where we see the role of PAs and AAs sitting and where they can add value to our healthcare system. Scott, do you want to say a bit more about that?

I think that most boards would say that they would prefer not to have to do it, if they could, but it is important that we set that challenge for them in relation to driving efficiencies in the system. It is a bit like the four-hour wait target at A and E; taking that away would probably cause more problems, because it drives some of the systems. The 3 per cent is a way of driving boards to make sure that they are looking at their expenditure and where they can be more efficient.

Notwithstanding the challenges that go with achieving that, it is an important challenge that we put to them. We make sure that we hold them to account for that, given the huge amounts of taxpayers’ money that they are responsible for spending each year, and that they are doing that as efficiently and effectively as possible.

As I said, that will cover HR functions, including payroll, that can be managed jointly.

It is worth adding that the changes bring the GMC within the competence of the Scottish Parliament. Ultimately, therefore, the GMC will be accountable to the Parliament and to this committee if the committee believes that the GMC’s approach is not consistent with what it thinks is the right way to do things. The committee will be provided with a direct route into the GMC, which has not been available previously.

I will ask Nigel Robinson to talk about the history going back to 2003, and why there was a change in the name at that point.