Mae ddifrif yn teimlo i'r Prifysgol i ddaeth i'r Prifysgol o'r mir Prince, i'r Poblik Oddych Gael. Byddwn i'r prifysgol i ddaeth i weld i ddyn nhw'r enthraeg ei wedi ymddangosol i'r rhyw ffrifysgol i'r unrhyw dechrau i gael ffwrdd. Mae bod ni'n gwybod o wybod felly rwy'n rhoi ar y maes dros Tybox Scotci, sydd eich gwaith i'r wyniad o dweud o'r mwneud i gael i symud pwrwysigol a'r cymdeithasol i'r rhannu, mae gennym wahanol fel David Torrance, gweithio o'r wrthglwch i ddigwydd o fel bethau am dd gravei. Mae hynny'n rhaid ulobeithio bei ddewidol ar hyn yn y bobl. Felly, dwi'n fawr iawn i gyfluso'r ddechrau, rwy'n ddegwel i hynny'n ddewid wych yn ei fyddechrau. Rwy'n ddegweld i'u ddewid ddewid continuity switches i'r ffansol, ac i'n ddewid wood wedi'i ddewid pwyllt, i', Dick Henry Cyn, Ken Macintosh o小 nhw, Paterson. Oedden nhw'r Comitee paeth yn ôl. Miannolaeth i Mitil Mellan a Dru Smith o ran y gafoddau'r ein ddyddau i'r Comitee paeth. Fydd nid o'r exlwm i'r ddechrau? Mae'r exlwm yn nid o'r exlwm i'r ddyddai. Miannolaeth i'r exlwm i'r ddechrau? Mae'r exlwm i'r ddyddai. Mae'r exlwm i'r ddyddai. Mae'r exlwm i'r exlwm i'r ddyddai. Rwy'nvio'r domainiaid i'r honnwch yn gweld y position of convener of the Public Audit Committee, Drew? Thank you, Mary. Can I nominate Paul Martin? Certainly. Are there any further nominations? Can I now confirm that Paul Martin has been nominated as convener of the Public Audit Committee and asked the committee to agree to this nomination? Thank you. Now, the committee has agreed. Can I congratulate you, Paul? I look forward to working with you on this committee. Thank you, Mary. Can I take this opportunity to thank colleagues for the election as convener of the committee? I look forward to working with the committee. Can I also take this opportunity to thank you, Henry, for his previous two roles as convener, because I think he was convener before that, and also to the previous members of the committee for their work? We have a great deal ahead of us, so can I move quickly to agenda item number three? The question is, colleagues, that we take agenda items number eight and nine, and private. Are we agreed? Great. Can I move to agenda item number four, colleagues, and welcome our panel this morning? First, I welcome Paul Gray, director general of health and social care, the Scottish Government and chief executive of NHS Scotland. I welcome John Matheson, director of finance for eHealth and analytics of the Scottish Government. I'm Alan Hunter, NHS Scotland performance director and Dr Aileen Kale, CBE, acting chief medical officer, Scottish Government. Parliwm, you're welcome this morning. I understand we'll hear a short presentation from Paul Gray that will take no longer than five minutes. Mr Gray. Thank you, convener, and congratulations to you on your appointment to this very important role. I'm grateful for the opportunity to make opening remarks, and I'll comment on the key messages raised in the Audit Scotland report. I think the first thing to say is that there is a challenging scale of change to meet the 2020 vision. The 2020 vision is that everyone is able to live longer, healthier lives at home or in a homely setting by 2020. We will have a healthcare system which has integrated health and social care and a focus on prevention, anticipation and supported self-management. We want to provide care as we do at the present to the highest standards of quality and safety with the person at the centre of all the decisions. As we work to achieve sustainable quality and the delivery of healthcare services across Scotland, we want to continue to deliver improvements in the health and wellbeing of the people of Scotland. On the specific issue of the demands on the health service and rising expectations, as Audit Scotland notes, demands are increasing as a result of demographic change, particularly the growing population of elderly and very elderly people and the number of people with multiple long-term conditions and people's rising expectations of healthcare, we recognise the significant demands faced by NHS Scotland and I welcome the opportunity to discuss how we are addressing those demands proactively. The integration of health and social care services that I have mentioned is crucial to meeting those demands, the Public Bodies Joint Working Scotland Act 2014 comes into effect from April 2015 and puts in place a framework to make sure that health and social care services are planned, resourced and delivered by NHS boards and local authorities together, working with partners in the voluntary sector to improve outcomes for people using the service and for their carers and families. Those shadow integrated arrangements are being set up and developing their integration schemes, which must be submitted to ministers for approval. Integration authorities must be fully functioning by 1 April 2016. In terms of Audit Scotland's references to financial pressures and waiting times, NHS boards in Scotland delivered a small surplus of £23.4 million against an overall budget of £11.1 billion. All boards have achieved their financial targets in the year in question, that's the sixth consecutive year and all boards are on track to achieve balance in 2014-15. Audit Scotland refers to the financial pressures faced by NHS Scotland and the need to increase the focus on longer-term financial planning. We continue to improve our practices and we believe that we have a strong and effective focus on long-term financial planning. This is demonstrated by the achievement of all boards meeting their financial targets. We've made brokerage arrangements on an exceptional basis and only where a board has demonstrated its ability to repay in full. I do want to say that we take the publication of section 22 reports by the Auditor General for Scotland very seriously indeed and we will continue to make progress towards addressing the issues raised. We undertake in-depth reviews of all NHS boards 3 and five-year financial plans regularly, including detailed validation of the core financial planning assumptions. We have on-going monthly monitoring and reporting at NHS Scotland level to ensure that financial performance is on track and that we take appropriate action in the event of any significant deviation from plans. On waiting times, the Government remains committed to supporting NHS Scotland boards to deliver the standards that are set in Scotland. Our waiting time standards are among the strongest in the world and performance in Scotland is among the best on record. However, there are challenges and we do recognise those in this year's local delivery plans. We have focused on NHS boards' improvement activity on outpatient waiting times. Just in closing then, convener, I welcome the acknowledgement in the Audit Scotland report of the good progress of the NHS in a number of areas, including improved outcomes for people with cancer or heart disease and on reducing healthcare-associated infections. NHS Scotland's recent achievements include world leadership in using improvement science to deliver outstanding results. That has really only been made possible through the huge contribution of patients, carers, families and volunteers as well as the dedication of the workforce. Convener, I am grateful for the opportunity. Thank you very much. Thank you, Mr Gray. Before I invite questions from members, remind members that case study 3 on page 15 of the EGS report on NHS 24, which is also a separate section 22 report on its own right, is currently subjudice. Members may wish therefore to note this when taking into consideration the questions that they may wish to bring forward. Can I, first of all, bring Mary Scanlon in? That is the first question. Thank you, Mr Gray, for your opening statement. I don't think that there is anyone round this table that doesn't agree with the improvements in health and wellbeing. That is something that we all want to see. As the Audit Committee in this Parliament, we are looking for measurable outcomes. I would have to say that the eight years that I spent on the health committee, we were also looking for measurable outcomes and we didn't find them then. Because of that, the previous convener, Hugh Henry, wrote to you some time ago to ask you that we consider NHS performance measures should be transparent, clearly understood, so patients, NHS staff and other interested stakeholders can easily assess the quality of care and timescales within the NHS in which the NHS is treating patients. It was my question on what is a target and what is a standard. I think that the previous cabinet secretary agreed that it can be confusing what is a target and what is a standard. We asked you to respond to that. The response is, as I can see it, 38 pages of bureaucratic fudge. I am no further forward to understanding a measurable outcome than I was in May 1999. My question, I really thought this was going to be helpful, helpful to this committee. Can you tell me how 38 pages can help us to measure outcomes? One of the outcomes that we are achieving is a significant and regular reduction in hospital standardised mortality ratios. That means that the mortality in hospitals is reducing over time. I believe that that is an outcome that is of value to patients and the people of Scotland. Ms Scanlon, I am genuinely happy to try to assist the committee further here. We are not trying to make this difficult to understand if there is something further we can do. I will be very pleased to do it. It used to be that if a target was not met, it became a standard. That is what we had. Targets changed to standards. You were going to simplify this. What I want is not just that this committee will understand it, but people throughout Scotland will understand the improvements that we are seeing in health and wellbeing. Can you tell me today how those 38 pages of bureaucratic fudge are happy to accept your answer? Can you tell me how that simplifies our understanding and the understanding of the people of Scotland how our health service is improving? We know when we have a target and it is not being met, we know where we are going. If I can just say that no health board achieved an outpatient target of 12 weeks, five out of 14 health boards achieved the inpatient day-case treatment time, five out of 14 achieved the A&E four-hour target, five out of 14 achieved the cancer, urgent referral treatment, and three out of 14 health boards achieved the delayed discharge target. It is not a great record, but next year we can say that that was the target that it was not achieved, but it has been made. Can you tell me how that has been simplified by this? As I have said to the committee, I am happy to provide whatever further information the committee wants. A target is something that we are aspiring to meet. It is challenging, but that is why we set it. A standard is something that should be met consistently by the NHS. That is the way we seek to set these things out. We have a number of heat targets. We have issued local delivery plan guidance to boards on both targets and standards. You mentioned outpatient waiting times. I think that I said in my opening remarks that one of the areas of focus for improvement that we have set for boards is indeed outpatient waiting times. If there is a simpler way that we can present this, I am happy to reflect on it on behalf of the committee. I take your point seriously, Ms Scanlon, and we will review that documentation. If we can simplify it for the committee, we will certainly do that. On that point, I would like to come to section 22 before moving on. What is the difference between a target as standard and a priority? Will you continue to have all of them in future? A target, as I have said, is that we are aspiring to meet it. We have a target of meeting 95 per cent of people seen and treated in an accident emergency within four hours. That is a target. We have certain standards that we have set and can go over these and colleagues and performance that can help us if necessary. We have given priority in the local delivery plans this year to improving outpatient waiting times. That is a priority that we have set for the boards this year based on an area that we believe requires improvement. That is the way in which we seek to divide things up. Priority, standards and targets. You mentioned section 22 that you take seriously and you will be aware, Mr Gray, that the committee is going to inverness to take evidence from NHS Highland. I have been quite vocal on the national resource allocation funding formula and NHS Highland and indeed Crampian, but we will just talk about NHS Highland, has not received its full funding formula and I have no doubt that is perhaps credited to some of the problems that it is facing just now. Given all the difficulties that NHS Highland is facing, as well as the section 22 report by the Auditor General, which is a very serious matter, why was it in the middle of winter that suddenly the Scottish Government came up with the money to meet the funding given that they have been crying out for it for many years? Why was the money suddenly found last week when they have had to struggle over many years because they have not been funded in accordance with the funding formula? I will ask Mr Matheson to comment in more detail, of course the committee will be aware that there was a decision on the distribution of the Barnett consequentials, which did provide additional resource for the NHS in Scotland and the additional funding for NHS Highland was part of that, so when that money became available it was distributed appropriately but Mr Matheson would... It was based on the additional NHS spending at Westminster which made money available in Scotland. I will ask Mr Matheson to give you the detail of it. We have a commitment within the Scottish Government that we will move boards towards enrack parity, in a measured way that does not destabilise those boards which are above parity. The commitment that was given by the previous cabinet secretary was that all boards would be within 1 per cent of parity by fiscal year 2016-17. What the additional consequentials have given us the opportunity to do is to accelerate that progress and all boards will now be within 1 per cent of parity by fiscal year 2015-16 that we started on 1 April. That is based on the current formula and as we have previously discussed at this committee that formula is a dynamic formula, so for example we did recently review the remote and rural waiting within the formula and that was beneficial to NHS Highland. The result of that is that NHS Highland for 15-16 will get an uplift of 4.7 per cent, so second only to Grampian in terms of the scale of the uplift and they will get an additional £24 million. In terms of the brokerage that they got last year, £2.5 million, it is important that all boards are made aware of their budget at the earliest possible opportunity and we do that in terms of giving them advanced notification, and in terms of working collegially across NHS Scotland so their planning assumptions are consistent around potential pressures around superannuation etc. We give them that, the assistance, we give them the information at the earliest possible point. We try and minimise the compartmentalisation of their allocation so we do try and bundle it round about themes rather than trying to give them individual allocations. We try to give them their allocation on the year. NHS Highland was clear about what their allocation was. They approached us towards the end of the year looking for assistance. We gave them assistance, as Mr Gray has indicated, and that assistance is predicated on its having reassurance that they've got a robust plan going forward and that robust plan included the repayment of that brokerage. We have now been able to give them further assistance in terms of an enhanced uplift and we're working closely with NHS Highland in terms of their financial planning going forward. Before I bring in Colin Beattie, can I just go back Mr Gray to the point that you made about the way in which the targets are presented and Mary Scanlon had raised issues about the public and how that's presented to the public? You advised that that's something that you would come back to the committee on. Is there a timescale attached to that as to when you would expect the committee to receive that and do you accept that the information could be packaged in a more effective manner to present it more effectively to the public? First of all, convener, is there a timescale that would be helpful to the committee? Perhaps we could write to you with a timescale on that? You can be happy to conform to that whatever will be most helpful to the committee. In terms of your question about could it be more helpfully presented, I'm sure we could always improve. There's never been my stance to say that nothing can be made better. For example, picking an LDP standard that we have at the moment, at least 80 per cent of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation. I think I just about understand what that means but I'm sure we could make that. I'm just using that as a simple example. There's something that we could make a bit clearer in a descriptive way. Of course, we have to be precise in the statement of the target. Even things like the 18 weeks referral to treatment for specialist children and adolescent mental health services. We have to do that 90 per cent of the time. It's probably helpful to people receiving these services to know what that means in practice for them. I'm sure there are areas where we could look at that we perhaps describe more fully what the targets and standards mean. Can I start just by asking a clarification? Mr Gray's submission of 4 December refers to formula capital. It's not a term I've heard before. What does it mean? I'll ask my accounting expert to explain it. Maybe that's something else that we could explain more clearly for the committee. Formula capital is the capital that is allocated to boards to deal with routine maintenance so backlog maintenance, purchase of equipment. The differentiation is between that and capital that is allocated for major projects such as the South Glasgow development, £824 million so there would be a dedicated sum allocated for that particular project but for formula capital it's allocated on a formula 8 basis, as the name suggests using the NRAC formula so each board will get a share of a total pot and the formula capital for 15-16 is a £15 million extra compared with £14-15 so the formula capital allocation is going up and a particular area of focus in terms of the utilisation of that is dealing with backlog maintenance. What's the terminology to cover capital for major projects just in case that comes up? Excellent. Looking at paragraph 33 of the report in NHS Scotland 2013-14 I'm just looking at the increases in outpatient appointments 34 per cent up in four years we talk about rising expectations as far as health is concerned it seems like a huge increase just to put it around rising expectations as to health and it's also a big increase even if you take into account the fact that we're all living longer 34 per cent that's an awful lot do we actually have a full grasp of what the reason behind that is? I'll ask Eileen Cale to give you some more detail but of course one of the reasons that will be part of this is that we are trying to treat more people on an outpatient basis rather than having them treated on an inpatient basis so there will be some structural change to the way that we're doing this but Dr Keele Yes, thank you Mr Gray I think the main reason is the demographic change the ageing population as people live longer they develop more chronic diseases have more comorbidities and therefore require in many cases multiple outpatient clinic referrals so I think that is the major explanation there may be others around that we don't understand quite so well but I think you need to look no further than the ageing population to explain that significant increase in outpatient referrals I mean that feeds through into paragraph 35 which talks about delayed discharges and that seems to relate mainly to patients over 75 who've got complex needs we've commented before in this committee that the transfer of resources from the NHS into primary care doesn't seem to be happening at the pace that it's needed and I would ask are we in a chicken and egg situation where we need to build capacity in primary care to be able to cope with the patients being discharged that they will need to look after with their complex needs and so on and at the same time how do we transfer the resources from NHS in such a way that the NHS can still handle that period of transition if that makes sense No it makes perfect sense Mr Witte well I'll come to John Matheson in a second on the primary care funding there's already been an announcement about some of that I think the delayed discharge situation is complex of course there is additional demand on primary care but there's also demand on social care and the availability either of care home places or care at home and our 2020 vision that I mentioned looks towards having more people living longer, healthier lives in home or a homely setting that's why the integration of health and social care is so important and I know that there's been 18 million of additional funding announced recently in relation to helping with that programme and to support some of the pressures faced and there's a further 10 million available for distribution this financial year so we are the the government is taking this very seriously because it is clearly better for people to be at home or in a homely setting than to be in hospital once they're well enough to go in terms of funding for primary care Mr Matheson I wonder if you might just say something to the committee about what's proposed for next year in particular in relation to that as part of the draft budget for 2015-16 there's a dedicated sum of money set aside called the integration fund and the totality of that fund is £173.5 million £100 million of that is going into board baselines and off the remaining element there's £40 million per ray per annum being identified and prioritised towards primary care there's also £5 million being identified for the development of mental health services and importantly there's £10 million being identified to enhance the infrastructure around telehealth telecare because Mr Beattie referred to delayed discharge and that is an important issue that we're tackling just now but part of the solution to delaying discharge is to delay admission in the first place so if we can get upstream through the intelligent use of telehealth telecare and keep people out of hospital deal with chronic diseases before they require hospital admissions then that is part of the challenge that we have and some of the work that we're doing partly with European funding money to try and get that to approach embedded across Scotland is an area of specific focus In 2013-14 the budget for the NHS increased by 3 per cent in cash terms which equates to about a 1 per cent real increase but still obviously makes it quite a challenge to meet these sort of exponential growth in patient demand and a number of NHS boards are having clearly having problems meeting their targets and the Auditor General has highlighted that several are doing so in an unsustainable way which is the fact that they are non-recurring savings what are you doing to work with these boards to help them to get on to a more sustainable basis and I'm talking specifically about the ones that have their non-recurring savings The couple of responses in terms of that part of the answer to that for the legitimate question is around long term financial planning so rather than just dealing with the question maybe the next year looking at where we're trying to get to in terms of 3-4 years out now that is our aim it's not helped by the fact that we've got a time limited spending review so the assuredness that we can give boards indication of what their budget might look like 2-3 years hence but we can't give them assuredness we've given them that at the earliest possible opportunity but that's dependent on the spending review cycle we have the 2020 vision in terms of where we're trying to get to so the strategic direction is clear the introduction of the health and social care and integrated budgets around health and social care will assist in terms of bringing together the budget resource and how it can be used across that sector but there are certain boards where we the overall reliance within NHS Scotland generally in terms of non-recurrent lines has been coming down and it's used to use a ballpark because there's always non-recurrent flexibility within the system the issue is is that being used on a recurring basis or has it been used on a non-recurrent basis so you made the point earlier about trying to create some investment space in the system so how it's been used is important we have going forward a commitment to give as much clarity to boards in terms of what funding is going to come to them in terms of the financial planning cycle we have three-year plans signed with most territorial boards the detail in years two and three is less rich than the detail in year one but we do have that commitment there there are a couple of boards at the moment that we are particularly focused on NHS Highland is one in terms of just looking at the level of non-recurrent commitments they have which are not funded through a recurrent resource so we are particularly working with the NHS Highland we put some specific resource into NHS Highland to work with them to look at the shape of services that they are providing and obviously they are an early example of health and social care so there's a potential there in terms of how they can progress that You touched on a very important point there which doesn't seem to be taken and highlighted in the Auditor General's report which is about non-recurring savings being used for non-recurring expenditure is that a valid point in relation to some of the NHS boards at the moment the ones that we are looking at that apparently have non-recurring savings which we on the face of it think could be a problem in the future because we just assume that it's against recurring expenditure I think Mr Gray mentioned the overall performance of the NHS in Scotland and against an £11 billion budget for the health boards they were £23 million and off that £23 million the £10 million was NHS Glasgow deliberately under spending to allow them to cover the anticipated double running costs around South Glasgow they're just about to move into South Glasgow at the end of this month which is fantastic, the project is on time and on budget but there will be double running costs linked in there so NHS Glasgow are prudently putting aside some money because that double running costs so that was £10 million of the underspend £3 million was a similar approach from Dumfries and Galloway that we within the Scottish Government then tried to manage that overall position within the totality of the £12 billion resource and the underspend within the health and social care directorates for 1314 was £4 million which is landing the helicopter and the drawing pin but the aim there is to ensure that we are maximising the amount of healthcare that we can get from the resources we have available and that necessitates looking at the inevitable non-recurrent flexibility that there will be in a year and looking at how that can be managed in an appropriate way to ensure that we maximise the delivery that we can get from the totality of the resource and that requires flexibility between boards and my colleagues just one last question we beat ourselves up here about targets percentages and what not do we have any figures how we compare with other countries south of the border for example in any European countries on similar statistics such as waiting times and so on do we have anything like that Mr Hunter will be able to help you with some of that Yes, we do and we pick up on issues around unscheduled care which clearly any patient waiting any length of time we want to address but it is important to know the journey that we've gone in I've been in the Scottish Government for about a year now but prior to that I worked in the health service and since whenever I worked in the health service there was always patients waiting a long time in A&E departments and in fact in Glasgow Royal Infirmary 10-15 years ago patients waited routinely for long periods of time and then what was introduced was a collaborative programme back in 2004-5 to address that and over the years there have been significant improvements we've seen some reduction in those improvements and there are some challenges in the system at the moment but it is important to put it into context that Scotland is still ahead of its international and UK comparators Do we actually have those figures? Yes, the figures are that in terms of Scotland 7.3% of Scottish patients attending A&E in September 14 waited over 4 hours on the same basis looking at major A&E departments in England 8% of patients waited over 4 hours so a marginal difference between England and Scotland in Wales 16.9% waited over 4 hours Northern Ireland 24.3% waited over 4 hours in New Zealand where the monitor a less ambitious 6-hour target we monitor a 4-hour target 6.2% of their patients waited over 6 hours in Australia 18.6% of their patients waited over 4 hours the reason for putting that is to put it into context that whilst we need to do more and we are going to do more for the Scottish population ahead of the game in terms of the pressures now these pressures are coming in because of an ageing population so we've had a 17% growth in admissions over the last 7 years and what is matching that admission is the growth in over 75 years' population so there's significant challenges in the system but we're working with the royal colleges other partners to try and identify where the next change in unschedule care in other areas moving on to other measures such as across the UK we looked at with the other UK countries looked at 11 areas of procedures waiting time procedures and we standardised against that 11 procedures and in 9 out of the 11 procedures Scotland was better than England and in all the 11 Scotland was better than Wales or Northern Ireland and that's based on the latest published answer Clearly you've got quite a bit of information there I suggest that it might be of interest to the committee to actually have that circulated to members the comparative figures that are available just so we can see where we are Can you facilitate that? It's a brief supplementary from Mary Scanlon and then I'll bring in Stuart McMillan It's very brief, we're constantly hearing about the ageing population and Mr Gray people being treated in a homely setting but the report that we have in front of us today page 40 exhibit 13 tells us that the 11% fewer there's been a reduction of 11% totaling 60,950 fewer people receiving home care Given that we've got an ageing population in a homely setting over a five year period we've got an 11% reduction we've also got a 10% reduction in care homes 36,500 reduction in residents in care homes Given that we're always being told people are older, they need more home care the provision of the service is going in the opposite direction to what we're being told is the level of demand Dr Keele, help us with the interpretation of these numbers Mr Hunter is going to help us I knew I was being nudged from the side I looked at those figures as well obviously and needed some interpretation so I got the position on that Although there has been a decrease in the numbers of patients receiving home care the actual spend and the number of complex care packages has gone up and that's in direction with what we're trying to do we're trying to keep more patients in their own home and so we've there's figures that I can share that shows that that's the direction of travel so although we're seeing more complex care packages in keeping people in their own home Is it the case that the eligibility criteria for home care has the barriers been raised compared to when the legislation went through this parliament in 2001? I would come back to you on that one I can come back to you on that but in terms of our direction of travel we've been wanting to keep people in their own home and there is more resource going into keeping people in their own home that matches those figures so I can share that with the committee 61,000 fewer people 11% reduction so you've got to be more ill in order to receive home care is that the case? We have got patients in their own home being looked after the direction we were going in was that direction Higher and more complex than there were 10 years ago Is that the case? The eligibility criteria has been changed Yes Thank you Good morning panel The first question is a point of clarification It's one of the new members that came to this from our fresh eye It's one of the submissions we got from Mr Gray regarding the clarification There's the issue of the backlog £830 million backlog and the further 97.6 million relates to the properties replaced with the current redevelopment projects I'm aware that in NHS Greater Glasgow and Clyde at the moment there is some discussion to potentially two new health centres either one in Clyde Bank or one in Greenock When I was reading this I actually wasn't sure as to where these two current facilities which category they would fall into would it be for new projects? The new facilities would be capital investment so that would not be a backlog issue that would be a decision about where Greater Glasgow and Clyde would spend money on investing in new facilities Okay, thank you Thanks for that When I was reading through the report a number of things kind of did strike me one of which was in terms of all the parties sitting around the table that struck me that there's something in this for all of us because it's clear that there are challenges I mean, yourselves have already said that this morning but that also there are some positives as well and the report does indicate that and also with the eye to the future there are challenges with that too but it's a couple of things that did strike me it was one of which was in case study 2 on page 14 the situation regarding NHS Orkney and the the board's spending on local doctors increased by 30% now certainly with the report to go on to indicate that there are issues there in terms of actually trying to attract people to Orkney now I don't know why because it's a beautiful part of the world but are you aware of what actions of what activities are NHS Orkney actually doing to encourage more people to get there are they that they have any flexibility to maybe offer other incentives to get people to go there to work the island boards of course have as you say some very attractive living conditions and very attractive to people who have that kind of setting and many do boards are able to offer certain incentives if they choose to do so within the overall salary and pay arrangements in terms of conditions that they have but I think the thing that tends to make boards most attractive to people is if they are operating on a stable and effective basis and I think that's why NHS Orkney are giving so much attention to responding to the section 22 report that they got to ensure that NHS Orkney is seen as a good place to work and a running and delivering a viable health service which in general it is but Mr Matheson will be able to say more about the support that we've been giving to NHS Orkney and the considerations that they've been undertaken I think that Mr McMillan and the other factor that will make NHS Orkney more attractive is the redevelopment of the Balfour hospital within the Orkney and that will happen over the next two to three years the NHS Orkney has got to clinical issues so I think that there's a couple of factors there one the point that Mr Gray made but the second one is how we have the potential for them to redesign the services within NHS Orkney so a number of the islands have had the GP-led services and whether a nurse-led service might be more attractive and easier to fill in terms of potential vacancies in terms of the specificity around the section 22 report we did recognise the fact that to the same principle on the small board the level of technical accounting expertise within NHS Orkney needed a bit of specific enhancement and we sent a colleague up from NHS Fife to give them that to a dedicated support around the time of the annual accounts but also some on-going support beyond that so we do try and give some central support where possible and I know in other areas they've had support and strong connectivity with NHS Gramping around communications and other areas of the support services they provide That's helpful On paragraph 24 on paragraph 24 and 25 regarding the capital spending when I read this particular paragraph 25 when I read these two particular paragraphs I actually I immediately thought of the convener of the local government regeneration committee Kevin Stewart because the words that he regularly used in that particular committee is that you can't legislate for common sense and some of the what's actually here the garden paragraph 25 that looked to me as if there was actually a there was a joined up approach taking place because NHS Gramping I worked on a position to actually spend the money at that particular time so that they wanted to put it back Now when I read that I thought actually that was actually a positive thing to do to actually work in tandem with the Government but I could also see why some people might think or might want to challenge it Can you provide a bit more information please on the rationale for what actually happened there What we do each year on the capital programme is we deliberately over commit at the start of the year in terms of the capital programme and that is anticipating slippage so there's a risk attached to that but we work closely with boards in terms of how we manage that risk so the level of over commitment in the current year was around about £20 million but we're still anticipating that the capital budget will come in online we supplement the capital budget so the sale of the buildings that are no longer used and required for healthcare provision and there's always a risk linked to that as well in terms of the timing of capital receipts the timing of the planning permission for developments etc so it's a dynamic source in terms of the funding that we have available but we work very closely with individual boards on a pan-Scotland basis going back to my previous point to make sure that we utilise the capacity of the capital resource that we have available and that requires some detail discussions Grampian is specifically mentioned here but NHS Grampian have had significant capital investment over the last number of years they've got the new emergency care centre at Aberdeen Royal Infirmary and there was a recent commitment to develop maternity and cancer services within the Aberdeen Royal Infirmary additional £120 million so that it's important that when we talk about the balance of care we talk about primary care investment and you were making the point about health centre developments in Glasgow so there's also been developments on the health service side at the forest and also imminent developments at Inverudee so there's a significant amount happening within the capital programme we recognise that overall the Scottish Government capital programme over the past few years and we've tried to protect the health capital resource by transferring money from revenue to capital to supplement the capital resource that they have available we've obviously had a major commitment recently in terms of the £824 million south Glasgow development and that's coming to the end of its investment programme there's a further £30 million of that £824 to be spent in 1516 so we work very closely with boards we're very ably supported by the Scottish Futures Trust in taking forward our work with boards we've just produced a 10-year capital plan so we spoke earlier about long-term planning we have a 10-year capital plan that's been agreed by the cabinet secretary and they're happy to share that with the committee if that would be of interest Ysle Nigwyddon Sorry Thank you I want the Clydebank although they're not in Glasgow although they're a part of the same health board they're not in Glasgow as I wish of Scotland additional MSP I want to just get that on the record I was referring to Greta Glasgow and Clyde No, that's fine but in terms of the process that has been under way certainly between 24 and 25 of the report has that been a similar process for some time or is that a recent initiative between the Government and the NHS The other approach has happened for a number of years what we've got to recently in the last three to four years we've got a very comprehensive asset management report on the state of the NHS estate and that's enabled us to quantify the level of backlog maintenance that was outstanding within the NHS and when we started in the 2011 and we split it between low, medium, significant and high and the totality of that investment required was just over a billion pounds so there's been a very clear focus on that within boards over the last two to three years and the commitment that's been given is that within excuse me, five years significant backlog maintenance identified in that original report will be removed and that will be removed either by corrective action being taken in terms of the maintenance of the facilities or recognising the capital programme that we have in situ so for example within Dumfries and Galloway the new Dumfries and Galloway will enable them to move off the existing site and therefore remove that level of backlog maintenance that's currently present I've got one final question Paragraph 39 of the report regarding the co-locating of staff and there was one of the carers centres within the west of Scotland they've actually got a member of staff, now this happened within the last year and a half two years they now have a member of staff who has an office based at a hospital to actually assist with people who are being discharged now I was very supportive of their application to get funds to ensure that it was going to take place because certainly beforehand they felt as if it would actually assist people when they are discharged and help with that whole process now it's in also within the NHS Greater Glasgow and Clyde area but is that something that you would encourage, would you actually be looking to do more of that and do more of that working with non-strategory partners? Yes, we would I think as we proceed along the path of the integration of health and social care it's important that it's integrated from the point of view of the patient on the carer and the family so that they don't have to go to multiple sources of advice in different places so the more we can do to ensure that there are single sources of advice and the advice is near the patient and the carer and the family the better. We'd be very supportive of ensuring that approaches like that were taken forward I'd like to think just a little bit further ahead if I may I'm conscious that any audit report is almost by definition what's happened historically and with some reference to current processes but it seems to me that one of the current processes must be to look beyond 2020 let me say 2030, 2040 and the reason I'm saying that is because some of us despite what our years might tell us now I think you've been around at the time and it would appear that statisticians tell us that this is quite possible and of course from the health services point of view life is just going to get more difficult and actually we all know that and I'm not seeing I think in anything or I haven't seen that's pretty that way any discussion about how things are going to have to change on that time scale and I suppose my first question therefore Mr Gray would be what level of thinking does go on and what is your current thinking on how we're going to cope with a significantly older population place well, within the health and social care directorates at the beginning of this month I set up a new directorate of population health improvement because I'm very clear and with the advice of senior colleagues here that tackling the overall health of the population is the way in which we are going to make a real contribution to addressing these future pressures that you rightly identify we have I think advanced healthcare systems across the world can tell a reasonable story about how they've improved their efficiency and sustainability and the quality of the care that they've provided but I don't think you would find an advanced healthcare system anywhere in the world that said we've cracked the issue of population health and Scotland has particular characteristics in relation to population health and these have been of long standing and contribute significantly to some of the deep-rooted inequalities in Scotland because I've taken the decision to establish this directorate that will draw in the best clinical advice that we can get in order to ensure that we make real progress on tackling population health it's going to take a long time and it's going to be difficult but I suspect if I get it right you and I will be the beneficiaries of what comes out of that but can I challenge you not on what you've said but on what the consequence of that is because if you and I and those around us have healthier lives for longer that merely defyrs your health board problem and actually then at some point that old age effect takes over none of us likes to think about it but we've all seen it and then we need the medical help that your well placed provide and of course if we've actually stuck around longer it's worse when we get there it's more complex the comorbidities that Dr Gil's already spoken about are then more evident so yes we may be deferring it and yes we probably nationally have to spend less in order to get there which is what we have to do first but by the time we do get there it's actually yet more complicated and yet more expensive and that's where I'm really trying to get us to how on earth are we going to be able to handle that when we get there that's probably a health committee question but what are you doing to think about it I would suggest as an ordered committee question Indeed and I'm giving you the assurance that we're on our way of thinking about it I'm not claiming to be finished yet Dr Keillol have something to add in a second I think the situation will inevitably be that end of life care will continue to be required it will be complex it will be acute but if we can shorten the period over which that is required then that in itself I think is beneficial both to the individual and the health service I always find it very hard for reasons the committee will understand to be the sort of economic value on end of life care it's a hugely important component and I think we need to get better at it we are getting better at it but Dr Keillol you'll have some useful things to say on that I think first of all before I come to the question we've focused so far in the discussion mainly on financial and performance management issues and they're very important but they're only important as a means to an end that's to improve clinical outcomes across patient care and the Audit Scotland report of course refers to those improved outcomes if we look back over the past 20 years expressed in rates of mortality who reduced all cause mortality by 36% cancer mortality is down by 26% CHD is 69% stroke 64% now how has that been achieved it's a combination of prevention and better treatment I mean treatments have changed dramatically when I started in medicine if you had a heart attack you were kept lying your back in a coronary care unit for nearly two weeks now people are up within a day or two and back home so that's just one example of how things have changed and they will continue to change but from where I'm sitting what we need is an emphasis more on prevention while maintaining the ability of the NHS to deliver improved treatments as they come along why am I focusing on prevention because what I would like to see is younger people coming through living longer but living healthier for longer so they're not developing all the comorbidities that the current population are developing and they may get into quite late age with only one or two as opposed to half a dozen so in the end the NHS resource required to care for them at the end of life will be less that is the aim and we're doing a lot around prevention we've got lots of investment in early years for example lots that we could talk about so that is the direction of travel getting upstream of the health problems at face the Scottish population at the moment and stopping them developing in the younger generation right so if I've heard you were right and I think I have seen some logical answers in there if I might put that kindly what you're suggesting is that we live healthier longer lives which has got to be good regardless the process of then dying is actually shorter and it's probably less complicated medically because we haven't developed some of those co-morbilities on the way and then you are entitled to view when we do get to counting the beings that that end of life process actually becomes cheaper and therefore becomes more manageable in health service financing terms which is how we actually have to discuss it and I think there is a degree of logic in there which I can understand and respect I wonder if I could assess one other thing because if I could come back to Dr Keill's original answer to the very first question which was about waiting times for outpatient appointments I think Dr Keill suggested that that was one of the effects of an older vanaging population which again I can entirely believe but I think coming back to something that Mary Scanlon was saying about the comprehensibility of the numbers in front of us I'm not sure I've seen many of these data broken down by age of the patient now I don't think you necessarily want to do everything that just makes a much bigger spreadsheet but it might be that some of the data like that could helpfully be broken down over years by age of the patient because we might be able to see some very clear indicators of why things are arising I think that's a very helpful suggestion it was already going through my mind that we need to have a closer look at what's in that thousands of outpatient numbers are coming forward now I suspect they are very much in the older age groups but we need better understanding of them Just a brief supplementary from Stuart Mill now bringing in Bruce Smith I'm happy if you want to take someone else in first OK, thank you Let's just sit on the long I'm sitting on paragraph 69 of the report that highlights the issue of the longer term financial planning and there's a potential risk to that as already has been stated there has been a reduced level of capital budget to the Scottish Parliament to the Scottish Government and it's anticipated that there will be less money coming to the Scottish Parliament going forward Everything that Dr Aikil said a moment ago in terms of where the ideal situation would actually be how do you marry up the two if we know there is going to be less money and we know there are going to be cuts to the Scottish Government budget so how do you manage to plan for that? In response to Mr Don's questions I think that Dr Keill and I have been talking about something that is 10 to 20 years out in terms of delivery although as Dr Keill said we've made significant progress in quite a number of crucial conditions In the short term two things perhaps to say one is that there's a 75 per cent correlation between delayed discharge and performance in accident emergency so in other words if you have more delayed discharge is that will put more pressure on your A&E department that's why tackling delayed discharge is not an important short term measure in terms of the performance of the acute sector as well as what happens in the home or in care homes it's critical for patients that they're out of hospital as quickly as possible but one of the ways that we'll meet the financial pressures that we currently have is to continue on that path of improved efficiency we're running a programme at the moment on patient flow through hospitals to ensure that that flow is as smooth and predictable as possible again we've brought in someone who is a world expert in patient flow because we think this is very important his statement which he made at the conference that I was at recently was that many countries are talking about improving patient flow Scotland is actually trying to do it I'm not going to claim success yet but we're making a real effort in that area so we're doing things to improve the efficiency of the system as it currently stands while trying to marry up that planning for the long term that Mr Don has rightly drawn attention to and these short term initiatives will make a difference we're putting in place a six point plan for the improvement of unscheduled care in hospitals that's been, we've worked very hard with the Royal Colleges on that Mr Hunter mentioned that earlier so we're taking seriously the short term improvements that we need to make as well as planning for the longer term three points, first of all the protection that the health budget has been given which murders the protection given by the Department of Health in England and is welcome and that gives us relative protection so we still have efficiency targets to face the focus of the committee today understandably has been partly around the increased resource the additional budget consequentials et cetera I think one of the challenges we have within the NHS is to look at how effectively and efficiently we use the totality of our resource and not just the marginal increase each year and the final point I would make is that the progress that's been identified and recognised internationally in terms of the quality of healthcare infection rates, readmission rates et cetera is really really important in terms of the effective use of the £12 billion when I talk about financial performance I talk about quality driven financial performance because you get the quality right there's a better chance of the numbers being correct and the final point is that after staffing the highest area of spend that we have within NHS Scotland is on prescribing we spend about £1.4 billion on drugs and one of our areas of focus here is around national therapeutic indicators and performance indicators in how we use that drug budget as effectively as possible Okay, Drew Smith Thank you very much, convener A couple of members referred to Mr Gray's helpful written submission on the issue of backlog Earlier I just wanted to maybe start there The health service is a hugely complicated thing because people are hugely complicated but on the specific issues primarily around buildings I'm just interested to know why we're a year going to be a year later and clearing some of the backlogs in the way forecast we talked about anticipated slippage earlier on in relation to something else do they take into account the fact that it's going to be slippage or can we just give and take a year on such forecasts Well, we Mr Smith obviously we would prefer to meet the initial targets that we set ourselves in terms of backlog maintenance of course some of the issues in relation to backlog maintenance are that when you start to get into a maintenance programme you discover some issues that were not visible on the surface and therefore things do take a bit longer so we're close to where we want it to be but we're not absolutely there and we're predicting that the high risk things will be dealt with fairly soon and at the next level down by 2016-17 all but 150 million of that but Mr Matheson is on top of the detail here and I'm happy if the committee wishes that he provides further detail I think the other thing that we're doing as I mentioned earlier is that we are trying to protect or protecting the formula capital budget from which the source of the funding of backlog maintenance comes 146 million to 157 million now that's not all on backlog maintenance that covers equipment replacement etc but the commitment we've given is that we will remove all high and significant backlog maintenance that was identified in the 2011 survey within five years either through actioning it and dealing with it or through the new capital replacements so the new sick children's hospital the new Dumfries and Galloway run of a Greater Glasgow and Clyde colleagues to come off the existing York Hill site, the existing Victorian Firmry site I think I've been on the committee around the time when we discussed some of those issues in that survey and I think what Mr Greaves presented in the written submission is encouraging, there's no doubt about that and it does give you some of your assurance and I recognise that there's progress being made but if we forecast something and then we don't meet it and then we have a reassurance that we are going to meet it in 2015 and the significant by 2016 it does take away your confidence in our ability to do that and that's the challenge I wonder if you just say a word about maybe the proportion of this that relates to essentially surplus buildings buildings that are unlikely to be used so for both high and significant what proportion of that is in buildings that are still key to the delivery of healthcare Mr Greaves I don't have that detail to hand but I will supply that detail happily to the committee okay I wonder if I could just turn to the issue community where it's acceptable of delayed discharge and maybe back to the issue of people again one of the things for me when we talk about delayed discharge but when my constituents come and see me they don't refer to their relatives as a delayed discharge to tell me a story of an elderly relative who perhaps towards the end of their life is experiencing a level of service from the health service which ultimately is often life limiting either in that it has made their condition or the variety of their conditions worse and it makes the the whole experience for that person and the people around them at the end of their life not what we would want it to be and I think we've got to what I'm interested in is whether or not you believe that there is any more that we can do to actually understand the personal impact on human beings of some of these problems around delayed discharge because we can measure the number of people who are delayed leaving hospital because of the lack of a care home place or because of the lack of adaption at home but do we measure the number of people whose health has actually been affected by that? Do we measure the fact that they are then back in contact with a GP or another specialist or back in hospital within a set period of time or do we measure the fact that if their life then ends shortly afterwards that their family may feel that their life ended sooner than it needed to because of the stresses all these things are any of those things measured? First to say two things Mr Smith firstly if there is a I'm not suggesting that you would raise it here but if there is a particular case that comes through on your constituency case load that you think you should draw to our attention I would genuinely ask you to do that because we the only way we can fix problems is to know about them so if there's particular issues please do raise them direct Secondly though the impact on individuals the key reason that we want people not to stay in hospital longer than they need to is not about money it's because it is not good for the individual I'm absolutely clear about that it is a less good outcome if you stay in hospital longer than you need to and the impact will be felt in either someone who stays in hospital too long being unable to return home because they've been in hospital for too long and they've lost that confidence that facility to be at home it will be evidence in that loss of confidence in the general way that they conduct themselves and their carers and their friends will see that so the reason we think this is something that is worth taking very very seriously is precisely because we already know that outcomes will be better for people who get to home or a homely setting at the right moment focusing then on seeking to get people discharged within 72 hours is actually ideal there's two weeks, there's four weeks these are important staging points but 72 hours is really what we're looking at in terms of getting people out when they need to be we're working with the seven local partnerships that have the highest the most significant challenges Aberdeen, Edinburgh, Falkirk, Fife, Glasgow Highland and South Lanarkshire we've got people working on that today to ensure that we do more Glasgow are actually making some good progress on to assess so in other words, rather than having someone waiting in hospital to be assessed being discharged in order for that assessment to take place so long as it is clinically safe for that to happen so I'd be very clear in responding to your point that we know that this does not produce good outcomes if we keep people in hospital for longer than they should be there and that's why we're so serious about tackling it financial benefits benefits to flow through the hospital benefits to A&E pressures and all of that but the core point is is better for the individual I wasn't trying to raise a specific case but I think we all know from on our case people who represent but people watching this people that they know and people that they've visited in hospital that they visit towards the end of their life a bad experience can destroy someone's confidence it can make them feel I don't want to go back into hospital I want to give up and that is the experience of too many of people and that's that kind of experience that I'm interested in and do we actually attempt to measure that because there'll be some people who are delayed in hospital and it doesn't have an impact on them particularly and they manage that and it's fine and they carry on to just be a final hurdle towards the end of their life that can be destructive for them literally personally but so stressful for their family who experience it alongside them I think that's why I'm making the point we do of course if there is a poor clinical outcome then clearly through the clinical governance procedures of the hospital that will be followed up but what's very important and you may not expect me to say this but I will what's very important is that if patients or carers or families have a complaint about the way in which they or their family member was treated it's really important that they make that complaint at the time when it's possible close to the point to do something about it people sometimes feel they shouldn't complain it's not fair to complain of course we like to be praised but we absolutely have to know what goes wrong as well there's an excellent patient opinion website that we're promoting in Scotland that's used across the UK but we've got patient opinion Scotland where we get a number of great stories about people who've been well treated but we also get some very important stories about people who haven't been well treated there's one, it happens to be an English example but I'll use it of someone who after four years has only now felt able to come forward and say where something didn't go as well as it should have done and the serious impact it had on them they've had an excellent response I've seen Greater Glasgow and Clyde responding very well to complaints and seeking to get in touch with the individual's concern so I want to keep in our minds that in the majority of cases we're doing very well but in some cases where we don't I do genuinely believe that it's important that we get the facts and the details from the families quickly so that if there's something we can do to redress the problem we get the opportunity to do it and even if there's not we can at least learn from what happened that was one of the big lessons of the Vale of Leven inquiry that there were things that could be done that we're doing we don't want to wait a number of years for something like that we want to know now I'm not yet just briefly convinced I suppose absolutely there'll be instances of complaint which specific things have happened they need to be resolved sure that's appropriate but there's also the issue of systems and the number of people who've got and the discharge who suspect will be down to issues like the lack of a space at a care home the lack of the appropriate adaption at home the lack of a care package around that person to facilitate them going home which is not really a matter of individual complaint but it's a systemic problem the resources are not in the right place at the right time I suppose my final question is to the extent to which you as the chief executive of the health service can actually resolve all of this without what's your sense of what level of change is required in local government because obviously we want to work in partnership that is our whole direction but there are competing demands here competing budgetary pressures competing decisions we will all be aware of local authorities who will be making cuts to warden services to provision of care alarms and different things at home and ultimately it's not within your gift to solve those no there are three things very briefly to say first of all I'm perfectly clear that I cannot resolve this all on its own but second point that's why the integrated joint boards are so important because these discussions in the past would be about is the health service putting pressure on local government decision putting pressure on the health service an integrated joint board with an integrated budget will see that picture as a whole and so in a situation where the health service can do it might save pressure and cost on local government there will now be an incentive to do that because that will be a two way incentive the incentive on local government to reduce pressure on the health service will be equal because there will be an integrated joint board with an integrated budget so there will be a genuine budgetary and resource incentive for everyone to work in the most efficient way together and the third thing to say is we must continue at the risk of repeating myself to put the person at the centre of this this is about a better service for people and the thing that I'm pressing at the moment with colleagues who are responsible for these areas is to ensure that we continue in thinking about the governance and the money and the resources we continue to put the person at the centre of the decisions that we take very very finely it relates just back to the figure that Mary Scanlon highlighted about the 11 per cent of care reduction in people receiving care at home and then later the figure for the delays discharge bed days rising by 9 per cent is it too cynical to say how direct is that correlation? well I mean there's a simple correlation in so far as if resource outside the hospital decreases pressure in the hospital increases but on the other hand if we get better at improving the health status the overall health and wellbeing of people who are leaving hospital then they need less when they get out there so again it's not a one way algorithm if we get better improving people's health status then they need less care when they go out if they're able to self manage their care rather than being dependent on resource provided by the state then that's in the interests of the individual because they have more control over what they're doing and it's the interests of the state because it's costing less so this is something that is a complex set of interactions but what we're doing is working to make sure that we make the best of what's within the health service and within local government to maximise the benefit for people Thank you, convener and my personal congratulations on your appointment. Having looked through it I think some of my colleagues have picked up on the fact that it's not everything is doom and glooming in the garden there's obviously challenges but there's some good points as well but just carry on just a little bit from where Drew Smith was in terms of the care home provision I think you've sort of almost gone there but you pointed out the pressures on particular areas such as Edinburgh Aberdeen and I'm assuming that's due to property pricing and all the rest of it something which you don't necessarily have a great deal of power over and given the difficulties that's been pointed out in the report and elsewhere I suppose in the health committee as well How do you anticipate the post-relations and how do you feel that the boards are learning from what's happened over the past few years where obviously the provision has in certain areas has become pressured and is there some degree of end in sight is there a plan of action particularly in those particular areas that you can perhaps help either the local authority or whoever with the problem Well I think you're right first of all Mr Kear to point out that the causes of pressure in different areas different geographies town cities is different depending both on the economic circumstances and on the demography of the area what we are doing is working with those areas that are under most pressure as I mentioned to ensure that they're thinking carefully about the solutions that are likely to work for them there are some solutions that will work pan Scotland but there are other solutions such as in relation to care homes and so forth which will have to be tailored a bit more to the area in question John Matheson and I had a very useful meeting yesterday with the chief executive of NHS Lothian and his finance director about some of the options they have for tackling some of the pressure that they face including basically changing the way in which some beds are used so that they're stepped down facilities available working with the local authority to ensure that over time facilities can be transformed that we currently own can be transformed into care home places so those solutions will have to work for the specific localities but yes we're working hard at that we're also at the health and social care management board hearing a report every two weeks from the director of health and social care integration to ensure that as a board we're sighted on what's happening across Scotland and not simply focused on particular geographies and we also discuss this regularly with the board, the NHS board chief executives to ensure that the two can learn from what's happening in other board areas If I may the other things that spring out at me in terms of going through in the pressure it's always occurred to me the pressures on drugs the generic type whether it's patented or all the problems surrounding obviously we have a new medicines fund don't we was it 40 million in terms of how all these new reforms that have come in are affecting the pressures that have been identified over the past year I suppose how do you feel how do you feel about the coming year is it going to be a bit more manageable in dealing with these new drugs the appropriation whatever just your comments on that would be helpful Alas Mr Matheson to say what we're doing in terms of budget in relation to drugs in particular I think Mr Kear 2015-16 is going to be another tough year the demographic trends are not going to start going downwards next year or the year after we are going to face demands on the health service there is growing demand from the public for the kinds of service that they want to receive there is demand on the drugs budget Mr Matheson mentioned it as one of the most significant aspects of our budget however what I also know is that boards are working very hard indeed to ensure that they deliver local delivery plans that represent financial balance for the boards in 2015-16 I'm not going to claim it's going to be easy but I do believe it's doable convener with your permission do you want Mr Matheson to say something three points one from a strategic perspective we have a policy prescription for excellence in terms of our strategic direction in terms of how we manage the pharmacy resource not just the drugs resource but the relationship with community pharmacists the relationship with drug companies so we have that strategic direction which is driven by our 2020 vision yes it's important that we focus on the new pressures but I go back to my previous point that we also need to look at the totality of how we spend the existing drug budget in terms of the £1.4 billion we have a a good generic rate you mentioned Mr Cair there's a level of generic prescribing but 80 per cent of our prescribing is repeat prescribing so how do we manage that effectively how is the engagement not just with the GP but with the primary care team the national therapeutic indicators around statins, around inhalers around protein pump inhibitors in terms of the detail around the financial resource we do recognise the significance of drug pressures we have for £1415 given an additional £10 million to NHS boards recognising the pressures they're facing in here and we've given them an additional £30 million in respect of £1516 ok, I'm aware of the time ok just a brief supplementary from Mary Scanlon then I'll finish with that question just a couple of points that were raised and I just lumped them into one but although Dr Smith didn't have an example I feel like I can use an example given that it was on television earlier this week although I don't have the patient's permission but the patient is called Debbie Michey and she wasn't kept in the Ian Charles hospital for 72 hours as a delayed discharge and she was held in that hospital for over a year and I know that you're all very well aware of it and we have health and social integration that's supposed to solve all these problems we've now had that for two years in the Highlands and that's one patient that waited over two years and can I just say, convener, if I may as an MSP for the Highlands since 1999 people are scared to speak out they're scared to complain and they'll say to me well say something but don't mention my name don't mention where I live don't mention my condition etc and I've got a list of complaints for all the cancelled operations at Rakemore last week but please don't mention my name because I'm scared I'll get picked on or I'll get put to the bottom of the list so I just want Mr Gray and I think he perhaps do understand that but the patients are scared to speak out and the staff are scared to speak out so the question was really about Stuart McMillan talking about all the cuts from Westminster the NHS budget at Westminster has been protected since 2010 and you've already spoken about additional consequentials that came to Scotland and NHS Highland as a result of increased spending at Westminster so convener I would find it helpful instead of listening to threats of cuts down the line etc because nobody knows what's going to happen in May if you would tell us in actual in real terms what have been the changes in the NHS budget since 2010 I think that that would be exceptionally helpful to this committee and my final point convener is and there's so many figures here but when it comes to a report card based on a policy of excellence the biggest scare factor of the NHS is that the GP thinks whoa I can't deal with you I'll send you for an outpatient appointment for that 12 weeks you don't know what's wrong with you that's a worrying, worrying time and it's on the back of Drew Smith's point and it's even more worrying that within this report that we have in front of us today between March 2010 and March 2014 there was a 4,200% increase in the number of patients waiting more than 12 weeks for an outpatient appointment 4,200% it went up from 157 to 6754 and an increase of 34% in the number of people on the waiting list now if my GP refers me to a consultant from that day forward I'm worried about what he's saying a 4,200% increase I just put those points on the record convener the panel may wish to respond in writing or orally but I felt I needed to see those points Mr Gray what would be of assistance convener my offer would be that on the real terms changes in the budget since 2010 we would write to the committee so that that's clear in terms of Scotland's point about outpatients I will read from the LDP guidance which we've issued having mentioned that this is a priority each and every NHS board is expected to achieve the 12 week outpatient standard and the LDP should include a delivery trajectory long waits for outpatient appointments are unacceptable and NHS boards must also eradicate waits over 16 weeks which is the long stop so that's what we've said in response to you instead of better we now want to make it better the third point I respond to very briefly is on patients being afraid to come forward I genuinely wish to place on record convener that patients should have nothing to fear from coming forward and if they believe they do and if they have evidence to support that I would be happy for them to come to me direct if it's an issue in terms of clinical care chief medical officer will review it if it's an issue in terms of administrative standards I and my senior team will review it I would say for staff there is a confidential helpline which is not run by us it's provided, paid for by us but not run by us there is also patient opinion where people can put up their details I would be genuinely anxious to encourage everyone in Scotland if they have a concern to raise it and I give my personal commitment that is something I take very very seriously indeed so if any member around this table or elsewhere has evidence that individuals, whether patients or staff are afraid to raise a concern I do want to know about it Can I just ask in terms of concluding question that this is my first time in the committee and I think your approach today has been open and transparent and I think you'll want to continue that but by way of background I think it would be helpful to hear from you perhaps some of your frustrations in terms of the fact that some of these targets that we referred to earlier haven't been met and some of this will be in respect of some poor management practices that have been in place through the various boards that are represented in Scotland and I just wonder by way of background can you not name in names but share your concerns and your frustrations in that respect because you are here before us today to represent where we put forward to you our concerns in respect to that so you must have some personal frustrations that perhaps those discussions take place internally within your organisation that you convey to the various board members and various managers due to poor management practices perhaps some of these targets that should have been met with the resources that have been made available have not been met. Let me give one or two points on that. For example we see excellent performance in NHS Tayside on delivering the A&E for our weight target and I'm very keen that other boards learn from that and learn from it quickly and Mr Hunter and others are active in ensuring that that's the case. I think that there was a critical report put in by NHS Healthcare Improvement Scotland on NHS Lanarkshire in December of 2013 17 December 2013 that did point to some management practices that were not efficient and to some governance structures that were unclear. NHS Lanarkshire have taken that very seriously and tackled it but yes it was a frustration to me that some of that arose because there were unclear management procedures unclear governance arrangements and I'm now asking other boards to ensure that they take on the lessons learned from Lanarkshire. Members in this committee will be aware of the difficulties that NHS Grampian faced. To start with the positive we had the annual review of NHS Grampian on Monday of this week it's like a different place there have been significant improvements in NHS Grampian but of course I'm frustrated that it takes a lot of time and input to get us there and what I'm seeing is clinicians who were previously disengaged, unhappy in some cases behaving quite counter productively now coming forward and saying we want to be part of the solution. It does frustrate me that we see at times to operate in a way that leads to frustration in the service which then bubbles out in doctors, nurses other professionals feeling that they need to express themselves in the press. I'm not seeking to inhibit the right of people to speak up when they think things are going wrong indeed quite the contrary as I've said in response to Ms Scanlon's point but it does frustrate me therefore that we don't yet in every case have the processes and procedures and the governance in place internally and have them dealt with. One of the things though I want to say that I think that in the health service there's a great deal of excellence that tends to go unnoticed and it does frustrate me that the public discourse tends regularly to be about the few things that have gone wrong and believe me when they do go wrong we want to know about it we want to fix it and I'll say in passing if we make mistakes or harm people we should apologise for it and should do it without reserve but it does frustrate me that all the discourse is about what isn't going well as opposed to much that it is and my last point if I may convener is this recognising that you and a number of other members are new to this committee or returning to it if a private briefing from me, senior officials and senior clinicians helpful we'd be happy to provide it that's not me trying to say I don't want to be on the record very happy to be on the record on all matters connected with performance delivery and accountability but if a private briefing would be helpful we'd be delighted to provide it Can I just say finally on that point then in terms of the poor management practices which happens in many organisations and I'm not claiming that it's but in terms of the consequences for those who have engaged in poor management practices and it has been brought to their attention that that's the case and you've sought to reconcile that and to make sure that they are taking it forward positively if they don't and we revisit this at some stage in the future and it hasn't been met I mean would it be your case as I think would be expected in any organisation that individuals in those positions shouldn't continue in their positions the obligations that were set to them and I'm not asking for specifics I'm just taking it as read that of course that would be the position The employers of most staff in the NHS in Scotland are of course the boards themselves but I've made it very clear to the chairs and the chief executives of NHS Scotland boards that I expect high standards of performance I expect people to be given the opportunity to recover if they haven't done well to have that drawn to their attention and to be given the opportunity to redress the situation but it's certainly my view that if having gone through a proper performance management process any individual not just in the NHS but in public service generally is not able to meet the standards of the job that are required then they either have to go to a different job at a different level where they can meet the requirements or move on to something else OK, can I thank the panel for the time this morning and conclude the committee for five minutes sorry, I'll conclude it suspend the committee for five minutes thank you colleagues we are now at agenda item number four can I welcome the other general for Scotland Gillian Willman director Mark Roberts senior manager from Audit Scotland can I ask the general to come forward with a brief statement sorry, Caroline Gardner sorry, I don't know why I've got don't worry, convener that's fine, thank you and happy new year to the committee I'm presenting this report on the 2013-14 of the Audit of the Scottish Police Authority under section 22 of the Public Finance and Accountability Scotland Act 2000 the Scottish Police Authority and the Police Service of Scotland came into being on 1 April 2013 and 2013-14 was the first year for which it produced accounts the SPAs accounts include the financial results of the Police Service of Scotland as the committee is aware that the process of bringing together the eight predecessor forces and the Scottish Police Services Authority was a challenging task and I undertook to keep the committee informed about progress since my last report in 2013 significant progress has been made and continues to be made I'd like briefly to highlight three key issues the first is the pressure that the SPAs finance function was under during 2013-14 this was in part due to the substantial challenge of bringing together the finance systems of the eight predecessor forces and the SPSA and in part due to the fact that numerous finance staff left under the SPAs voluntary redundancy and early retirement scheme in addition, there were protracted discussions to establish where responsibility for the finance function should lie between the SPAs and the Police Service of Scotland this led to a delay in appointing a permanent director of finance and also generated uncertainty among the finance staff about their future permanent roles and responsibilities the SPAs appointed a permanent director of financial accountability in 2014 and this puts the SPAs in a good position for the future the second issue arises from the pressures experienced by SPAs finance function during 2013-14 the auditor Gillian Warman on my left gave an unqualified opinion on the SPAs annual report and accounts for the year but unusually she expressed a modified conclusion on the matters that she's required to report on by exception she concluded that for certain areas adequate accounting records had not been kept during 2013-14 this meant that the audit was difficult to complete and more importantly limited the information available to support decision making by the SPAs and Police Scotland during the year thirdly, the auditor assessed progress against the recommendations in my November 2013 report on police reform as highlighted in exhibit one of today's report the SPAs has made progress or completed the majority of these recommendations the key area where work remains in progress is the development of a long term by which for the avoidance of doubt I mean into the mid 2020s a long term financial strategy that takes into account all the additional cost pressures facing the SPAs having such a future strategy in place will provide a road map to help ensure a sustainable future for policing in Scotland the SPA is continuing to develop its strategy based on its strategies for workforce estate, fleets, ICT systems and procurement and I've asked the SPA's auditor to continue to monitor progress in this work as part of the 2014-15 audit alongside me a Gillian Wallman an assistant director with Audit Scotland and the appointed auditor responsible for the Audit of the Scottish Police Authority and Mark Roberts a senior manager with Audit Scotland who leads on our work in the justice area as always convener we're happy to answer the committee's questions and you'll forgive me if I may rely on Gillian and Mark more than usual given the state of my voice today thank you thank you to the other general first of all I want to thank you for your statement I think we've got questions from Colin first of all Colin Beattie thank you convener clearly the important thing here is that the auditor has an unqualified opinion and I assume that the basis of that was that despite the deficiencies that they encountered they were able to satisfy themselves as to the accounts of the SPA would that be correct absolutely Mr Beattie I'll ask Gillian if I may to talk you through what happened and how she arrived at a clean opinion with the modification that I've described thank you I have a very evident question to ask in these circumstances at all times the external audit was carried out in accordance with the Audit's Guide of Audit Scotland in order to see all of the audit evidence and seek all of the information and explanations we required in order to reach a final audit opinion the audit opinion on the financial statements was an unqualified one however since 2010-11 there has been an extra part to the audit opinion which highlights areas you may have to report by exception and consequently the modification arises in that area which relates to the adequacy of accounting records and information and explanations that we received in particular areas but I would like to assure the committee that there was very much a full scope audit that was undertaken in order to reach the unqualified audit opinion on the financial statements I think that's a very important point to put on record given the scope of the merger which took place which is almost unprecedented in Scotland at least bringing together nine different financial systems was the level of difficulty in the first audit commensurate with the complexity of bringing all that together I think that as I said in my opening statement first of all we absolutely recognised that complexity there's no doubt this was a very big merger in any terms and that would always have had an impact over and above that there were the delays that were caused in agreeing who had responsibility for the finance functions between SPA and Police Scotland and the consequent delays in appointing key members of staff adding into that the departures of staff under the voluntary severance and early retirement schemes the uncertainty that remaining staff experienced all of that added to the unavoidable complexity that Gill and her team had to deal with I think Can I ask about just a couple of specifics on these inadequacies I mean in your submission to the audit committee here you talk about adequate accounting records have not been kept what actually was that can you define that Yes I'm happy to respond to the detail of that question My actual audit opinion does highlight its aspect of the accounting records in the areas of fixed assets bank and cash and supporting documentation for the calculation of key accruals in the balance sheet at year end so what we were looking for and what we discussed through the planning process and working closely with finance officers was our expectations about what accounting records would be readily available for the audit work during the year 2014 what did happen in due course was that there was a delay in the production and passing over of particular records relating to fixed assets when they were forthcoming after a period of time they weren't right up to date for the transactions of that year but we worked closely with client officers to determine where the transactions were recorded and consequently we revised our audit approach and we did additional audit work than we might otherwise have done so that gives you an idea for that particular area So just to clarify that it wasn't that the records were incorrect they were incomplete at that point they weren't up to date Is that correct? Yes so we were seeking audit evidence for the year 2013-14 for the audit of fixed assets we would be looking at fixed asset registers we would have expected them to have been up to date and it was only at the end of August 2014 which several months later that after the year end which we were auditing there was clarity that they hadn't been kept up to date however the transactions had been recorded elsewhere directly on the financial ledger but it had taken time to receive those explanations to enable us to then progress with the audit work quite a bit later than we would otherwise have done Okay so there were delays and there's obviously some cost involved in that I would imagine Can you quantify that? We're currently discussing with the client the additional time that was incurred and what that means in terms of cost You have a ballpark? We haven't raised that directly with the client at this stage You're talking about property plant equipment the Solana Cruels Is that the only problem that was encountered that seems to be the main focus of what you're talking about but was there other aspects of the accounting? We have produced a year end report an annual report that has gone to members of the Scottish Police Authority We also produced reports during the year interim management letters and again those have gone to the Audit and Risk Committee where we've highlighted weaknesses of internal control but the full report at year end is quite extensive but for the purpose of the audit opinion we drew out those areas that we felt were of such materiality to the overall opinion and those are the areas we've honned in on Okay Would you say that the deficiencies you've found were broadly commensurate coming back to my original point with the complexity of the merger of nine different areas because presumably these areas were all using different systems although the principles of the accounting might be the same the actual physicality of bringing it all together within a fairly short period must be quite difficult The organisation that had responsibility for the preparation of the financial accounts was in no doubt the size of the challenge for the first year of these two new organisations nevertheless over the period of time and over the period of the audit there were additional weaknesses that came to light and as well as us identifying findings that required amendment in the accounts between the draft and the final the client also identified additional information that came to light at their end which meant changes had to be made to the accounts Would you say that the SBU finance people were aware of these deficiencies and were working on them or were they unaware? There were changes in personnel over this period of time leading the finance functions and they too had to seek and work with a wider community of finance officers across Scotland to glean key pieces of information and some of that information that came late so that was internal communications I think, convener, could I just add to that by saying the underlying causes come back to the two things that I highlighted in my opening statement the delay in agreeing where responsibility would sit and the consequent turnover and instability of staffing up until a point after the end of the first year those posts have now been filled and people have got much more certainty about their roles and responsibilities in future the establishment of the SPA and Police Scotland to the period after the end of the financial year filling some key posts meant that there was a great deal of pressure on those individuals and that lack of an ability to make progress with the things that I think we would all agree would be the basics for good internal control and good financial management and reporting You said that you issued reports on various aspects to the police authority Yes Have you heard responses on that? Have they taken them on board? Are they actioning them? Yes, it's very much part of our normal practice of any audit that we issue interim management letters during the course of the year All of our findings are discussed with officers before the finalisation of the report we get management responses as to how they are going to take forward the actions The reports are discussed at the Audit and Risk Committee and there's effective scrutiny by members to ensure that officers are engaged with the issues that internal and external audit raise and yes, we're confident that actions are being taken forward to address these areas Will you be following up on that on a continuing basis? We will The first question is in relation to the recommendations As a member of the Audit and Risk Committee I would imagine that the recommendations are about scrutiny, effective spend and everything I was actually surprised to see that seven out of eight recommendations are recommending that they continue to work together Does Police Scotland and SPA need to be reminded by the Auditor General and Audit Scotland to work together? I think it's worth reminding ourselves that the recommendations on which I'm reporting progress this time were recommendations that appeared in my original report in November 2013 At that stage there had quite recently been an agreement about who would play which roles in relation to the central services required and the emergence of more clarity about who would take lead responsibility for which issues The recommendations date back more than a year We're now reporting on progress and I certainly feel it's good news that for most of those recommendations we're now seeing them as either complete or progress I'm bringing them to the attention of the committee given the level of interest there's been in the creation of this new service over the period of its life since April 2013 Take for granted the public spend and the single police force that the two people at the head would work together My second question is a follow-on from Colin Beattie's and although you state in your conclusion paragraph nine certain accounting records were not adequate you go on to say and difficulties were encountered in conducting the audit I've heard the response about the accounting records of the different police authorities not being the same etc but what difficulties did you encounter on top of that in conducting the audit The two are very much related in terms of trying to establish where the up-to-date accounting records were who was responsible for them at that time and gleaning sufficient audit evidence that was passed over to the audit team for us to carry out our standard audit work and to reach conclusions based on the assurance that we could draw out and again I think this links up very much to the fact that at the time there was a period of transition for the finance teams as they came together some departed, some roles were changing and some permanent roles and functions were not yet known at that time apart from the inadequate accounts and difficulties we will leave that one there the third point the ICT system I understand is still under development I also understand it's been postponed again until September 2016 I wonder if you can give us an update on that and how that will affect duplication or how that will affect potential savings going forward and just at the same time I could perhaps ask about the payroll system which I understand in certain areas is currently administered by local authorities but my understanding is there will be a single payroll system in March this year so the ICT system and the payroll system can you give us an update on how it will affect duplication and the savings that we are all expecting I'll kick off if I may, Mr Scanlon, by saying that what we've done in this report isn't to do fresh audit work on new areas we've done the work required for Gillian to sign her audit opinion and to look at progress against the eight recommendations that were in my November 2013 report Mark may want to pick up on the question of ICT and the way we're planning to look at that in future and Gill may want to add to it In terms of ICT some of my colleagues have been in discussion with HMICS with regards to what work is going to be going on over the next few months in terms of monitoring and evaluating progress on the implementation of the I6 programme as the Auditor General says we don't have any more detail based on this report but it's one of the key areas that we're very interested in monitoring and assessing as what goes on Gill may want to add briefly on the payroll system that you asked about Yes, in the course of the 2013-14 audit on which we're reporting we're right up to date with the arrangements for payroll that continued a legacy arrangement with those local authorities that had been acting on behalf of the joint boards before in this area in terms of going forward certainly highlighted in our interim management letter their attention to the service level agreements and the length period that they continued for we have yet to find out more information as we undertake our 2014-15 planning to determine the arrangements that are going to be in place for the payroll system going forward so I've yet to glean that information as the Auditor General It's on target for March 2015 like six weeks away you still don't have the full information going forward that's perhaps something we can As the external auditor I'm not in a position to say to you whether the payroll system is on track for March 2015 Can I just convener ask Mark Roberts the information you have is it true to say that the ICT system has been postponed again until September 2016 I don't know to be definitely honest what I'll do is I'll come back to the committee on that and confirm once I've spoken to some of my colleagues we had a meeting with HMICS to discuss this very subject yesterday so if it's all right, convener we can reply to the committee in writing The brief supplementary from the con Your guidance on this we haven't really had any evidence on ICT and payroll systems and so on so we've really no basis for discussing it at the moment I would say If it's information that can be provided it's it's not only brand helpful but I don't think we should seek to take evidence on it but if it's information that can be helpfully provided by way of background That's all at least Scotland's corporate strategy If it's information that can be provided but I don't think we're looking to take any further evidence in that respect as what's before us today that will work on Nigel Don Morning colleagues I'm just wondering if I could clarify my understanding of what the words mean and forgive me if I get into very simple engineering kind of words I'm all right in thinking that you get an unqualified report on the accounts if the numbers add up but the comments that you've made are essentially about the systems that you've found because as an auditor you really want to be convinced that all the stuff that you haven't seen because you never see everything is credible That's right, the auditor opinion is giving a professional view that the financial statements of the organisation give a true and fair view of the financial picture in line with all of the professional standards that financial reporting has to comply with and that we do as auditors and there's no question about the financial statements give that clear and fair view What the modified conclusion conveys to me as Auditor General and on to you as this committee is that the process of getting to that opinion was more difficult because of the inadequate records during the year than we would expect it to be That is an unusual thing to happen as Jill said this requirement came in in 2010-11 and this is the first time there's been a modified conclusion Given the level of public interest I think that's worth drawing to the committee's attention but very much in the context that we also recognise the improvements that are being made in financial management and financial reporting within both SPA and Police Scotland And to return to the point that my colleague Colin Beattie has just made, if you're putting nine organisations together one really can't be surprised but, and this I guess is my second point convener, he spoke Auditor General about voluntary redundancies and the loss of presumably fairly important people in the context of the systems that you're talking about I'm just wondering whether anybody has reflected on the wisdom of that voluntary redundancy process and whether perhaps people have learned a lesson, I mean my recollection from my time in industry was that voluntary redundancies were not available to everybody because there were some people who were plainly were needed and I'm just wondering whether that's a lesson that might have been learned in the context of public service in general You're absolutely right about the general point our former report on managing mergers in the public sector made that point about needing to be clear who were the key people and the key skills that were required and making sure they were in place during the transition I think there were particular challenges in this case because of the number of bodies being merged the eight former police authorities plus the Scottish police services authority the fact that they were dispersed around Scotland and the fact that one of the rationales for the merger was to make savings that would help to ensure sustainable policing now those challenges were there anyway but the delay in agreeing who would take what roles and therefore which staff would be needed made that more difficult made it harder to make sure that people were kept during the critical period were available to build the new systems and frankly were available to provide information to Gillian and her team when they were doing the audit the genuine complexities of doing this were made more difficult by the delays that were encountered and I think it's worth noting again that as well as making the audit more challenging and that's a fact and I'm very grateful to Gillian and her team for the work they put in to being able to deliver a clean audit certificate it also meant that the information available to Police Scotland and the SPA to inform their decision making was not as rounded and complete in the year and that has an effect as well on the way public money is used that's part of why I'm bringing this report to the committee today while fully recognising the progress that continues to be made in resolving those issues okay thank you I'm just wondering if I could just simple point of information are you going to go back for next year's annual report Gill will be auditing the accounts of the SPA including Police Scotland every year to do my decision on whether to report to this committee and to the Parliament depends on what comes out of that audit as it does in every other case at some point I'm sure we will go back and have another in-depth look at the performance of Police Scotland and particularly the progress in developing and delivering a financial strategy but for now there are no firm plans for when that will take place thank you I think everyone recognises that the complicated business to bring these eight forces plus the other boards together and that isn't a surprise but it wouldn't be surprising that you would need to have somebody in charge of the finances and you would need to be clear about who that was I suppose we've had this extraordinary spat between Police Scotland and the police authorities being played out in public but what you're showing is kind of the underlying reality of what that kind of relationship between those two organisations created in terms of the flow of information, record and information properly you described here as a protracted negotiations to decide who was doing what it was a squabble basically wasn't it we'll understand Mr Smith that as auditors we aim to use language very clearly about what's going on and we reported on the history of the merger in full in November 2013 I think what we are seeing now is the legacy of the problems that were experienced in the early months leading up to the merger and the transition to the new arrangements there was uncertainty about the intention of who should be leading on the provision of support services whether it should be the SPA or Police Scotland that took time to resolve and eventually the Scottish Government moved in and broke an agreement between the two parties we're now seeing real progress and we're also seeing the legacy of that delay coming through in order to have confidence in the arrangements that now exist are going to be successful is it necessary to understand where the responsibilities lay? Between either organisation do you put it squarely and say that both of these organisations have different views about how that should work that's been resolved and we just need to move on or is there a particular one organisation was more overbeidding than the other about the way it wanted to do things or there was a real difference of the kind of way they wanted to go about doing this job I think this was a core issue in the report that I published in November 2013 and as is very often the case problems and situations that are to a great extent about the roles that individuals play and the different perceptions they bring it's not possible to say that one person or one organisation was responsible what I did say at that stage though was that the lack of clarity about who would do what that was inherent in the legislation and the wider planning didn't help and that there may have been scope for the Government to have helped to resolve that more quickly now that's a different thing I'm looking to reopen those questions what we're saying now is that there were consequences of those delays during 2013-14 in Gillian's view particularly the staffing has now reached a stable state which is a good thing and we'll continue to monitor the way in which the people who are now in post are delivering what they're responsible for in terms of good financial reporting and overall the good use of public money to support policing in Scotland thank you on paragraph 9 of the document you highlight the issue of suppliers being paid in a timely manner how much of an issue actually was this and was this as a consequence of maybe some bills and invoices maybe not being paid in the previous financial year that then carried forward to this particular year I'll have Gill to answer that in detail but I think the point I was trying to make in that paragraph was that the finance staff within SPA and Police Scotland were working very hard to keep the show on the road and that there was inevitably within that a process of prioritisation what are the most important things to be done Gill, do you want to add to that? Yes, I guess as the external auditor as we're looking at the financial accounts and in this paragraph we're trying to provide assurances that the management accounting throughout the year was being maintained that was an important area for informed decision making to take place throughout the year so this paragraph is intended to give confidence about those finance staff that were in post were working very hard and they knew their priorities were at the interface to ensure supplies and pay were all kept up to date during that first year With that particular part in this paragraph was that an issue? No, there was not an issue for the payment of suppliers Can I just say a conclusion on one question in terms of the actual process that was followed which we've talked about we are looking at substantial sums of money in terms of what the both organisations are responsible for so obviously public scrutiny is an important role in that Is it something that you've looked at when you've made the demands and organisations of the information that you've expected for them to respond to you on? Have you not looked at it in reflection and thought perhaps there should have been more priority work done to ensure that that information was provided so that your job would have been much easier than it sounded if it ended up in the end? You're absolutely right convener policing in Scotland costs about £1.8 billion and it's a service that we all rely on and expect to be there when we need it in my report in November 2013 the point that I was making was that for a change of that scale the run-up period was quite short for good reasons and the areas that were left uncertain left open the potential for the delays that we then saw in agreeing who would play some of these key roles in managing and reporting the finances now in terms of lessons learned the committee has had the Scottish Government's assurance that those lessons will be learned for any future moves of this sort but I think the underlying point that I'd like to bring out is that for any organisation spending public money and delivering public services having good financial information good financial records isn't a thing that we're only interested because we're being counters as auditors but one of the underlying ways in which we all know as citizens and you as parliamentarians that public money is being properly used and properly accounted for I'm very pleased that the amount of progress that's been made now has been made with an SPA and Police Scotland and I felt it was appropriate to bring to this committee's attention the challenges that were experienced as a result of those delays during its first year of operation but I wonder though some of us here today are new to the committee so we don't know all the background to this but I do wonder what lessons have actually been learned from the process because they say significant public funds I can think of other organisations who receive quite significant public scrutiny and who have information has been asked of them and they see it as an absolute given that that information just has to be provided or other organisations can't continue to function so I suppose the question I'm asking is yes you've highlighted some of these areas where there's information provided and that's been provided and that's led to the report you've provided today but I suppose the point then is that somewhere along the line the information hasn't been collated properly or the information has not been able to be collated what lessons have been learned to ensure that for the organisations in terms of the new organisation that's been created that that's something that's been dealt with and I would expect to have been dealt in quite a robust manner to ensure that these significant public funds here are not being I've been recorded properly Within SPA and Police Scotland I think we're very confident that now the foundations are in place for good financial management in future the people are there, the roles are clear the backlog of work in terms of pulling these information and the systems together is well underway in Jill's estimation and we'll continue to monitor that the bigger question of changes and mergers like this in future the committee has the government's commitment to making sure that lessons are learned in future clearly change on this scale doesn't happen very often which is one of the reasons why it's so challenging but where there are future mergers or reforms that bring up the same sorts of questions the committee has my assurance that we'll continue to be looking closely at it and making sure that the lessons are being learned at an early stage not just when the reform is complete at the end of the process Okay, any follow-up questions from colleagues? Okay, thank you Now the train is on the team for contribution today and I'll have some time for the change over to take place Okay, colleagues, we're going to move on to agenda item number six and before we move on to that can I just advise colleagues that the former Glasgow North college was a college which I was the constituency member for up until 2011 so just to understand there's clouts of interest but I just thought I would draw the committee's attention to that so before us today colleagues with responses from the Scottish Government and the Scottish Funding Council on the Auditor General section 22 report on the 2012 2013 audited accounts of the North Basel College because you will be aware there's been a number of changes in committee memberships since this has last discussed on the 19th of November members should note that the North Glasgow College no longer exists its merger took place on 1 November 2013 with Stowe College and John Wheatley College to form Glasgow Kelvin College in addition the submissions before us today from the committee's consideration on the 19th of November and the Auditor General's report from the Glasgow Kelvin College I wonder if I could invite members to comment on the submissions they've received and any action that they would propose to the committee I have to say that the submissions we've received don't change my opinion on this from the last time this was discussed the whole thing is absolutely outrageous the way it's been handled I think that the fact that the main college concern no longer exists is enormous difficulties but reading through everything there seems to be every evidence that at the very least there should be some sort of investigation in respect of negligence possibly even incompetence to be quite frank I feel very strongly on this the whole thing has been so badly handled you look at some of the points that have been raised which say the remuneration committee hadn't met for a number of years it received inadequate management support was unaware of SFC guidance and you go through all the paperwork on this and frankly I would have thought it merited a proper investigation as to how this happened now this committee is obviously not an investigating committee but maybe with your guidance convener where can we take this next if the entity still existed it might be easier but it doesn't exist where can we take this where can we escalate this for further investigation I absolutely agree with Colin I think it's outrageous and I think it's a sad reflection on the auditing procedures we're constantly being told lessons have been learned things are in place we've now got merged colleges and in the future they will adhere to a public finance manual and this won't happen again but the fact is that it did happen and we had individuals awarding themselves around three quarters of a million pounds of taxpayer's money thank you very much and their defence was they hadn't met for a number of years inadequate management support I read the Scottish funding council response to this and to be honest I really wasn't impressed by that either guidance is on the website and if only you'd had a look at the website everything would be fine so I think it's you know passing the buck gold plated passing the buck but I do feel convener I don't know what the way forward is but you know the entity doesn't exist as Colin Beattie has said I think it's an audit committee three quarters of a million is money that would go a long way towards home care and other issues within our public service rather than being awarded to college principals and vice principals I don't know what we can do it seems to me that they have probably got away with it I'm pleased that this was brought to our attention by the auditors I think it was Scott Thornton and I would like advice as to how we can go forward or advice as to if we can take this forward but I'm pleased to put on the record that I fully agree with Colin Cair and the information very concerning information we've had around these huge pay-offs now our colleagues want to contribute a simple question in terms of these particular reports and the level of work that's taken place on this well it's a similar piece of work going to take place for the other merged institutions Colin Beattie just one thing in the submission from the Scottish funding council the last page there it says it should be noted that the Scottish public finance manual does not affect the non-incorporated colleges how can we reassure ourselves that they're adhering to proper guidelines if there are guidelines in order to ensure that they don't encounter the same problems I mean the public with funded bodies there's got to be some accountability how do we do that how are they accountable I think that if we do need an assurance that this can't happen again I think that that would be very helpful and I think that's a good point I think from the contributions from colleagues today it's the colleagues feel strongly and the response so far is unsatisfactory so can I suggest to the colleagues that we write to the Scottish funding council expressing their concerns and the fact that we're not satisfied with the latest response and seek their guidance in terms of how we make it clear to them that we wish to take it forward and to seek a further response to them on that basis is that acceptable okay, thank you colleagues move on to agenda item number seven and advise colleagues that we are a further response to the committee's report on the NHS financial performance 2012-13 and the NHS waiting lists published last June the committee considered the Scottish Government's substantive response to the committee's report on 5 November 2014 and agreed to note it the response that members have before them today is the final outstanding part of that response members will note that the response explains the terms of improving the terminology used to report the NHS's performance the Scottish Government intends to provide a focus set of priorities and standards those standards are summarised in page 12 of the local delivery plan guidance I could just draw colleagues draw colleagues back to the discussion we had earlier today with the evidence that we received from Mr Gray and he gave a commitment to come back to the committee on the very issues that we have before us in this agenda item can I suggest that given that he's given a commitment to come back to us in that that would satisfactorily deal with this particular item agreed okay, thank you colleagues for that and can we move on to private session