The Scottish Parliament - Finance Committee Report

1. The Health and Sport Committee considered those parts of the “Health and Wellbeing” chapter of the Scottish Government’s Scottish Budget: Draft Budget 2010-11¹ (“the draft budget”) that relate to health and sport. The Committee has no remit for the other sections of the chapter – housing and regeneration, wellbeing, the Food Standards Agency and central government grants to local authorities – and has therefore made no comment on those sections.

2. The Committee agreed to pursue two objectives in scrutinising the draft budget—

3. On 30 September 2009, the Committee took evidence from Dr Kevin Woods, Director-General Health and Chief Executive NHS Scotland (“the Director-General Health”), John Matheson, Director of Health Finance, and Liz Hunter, Director of Equalities, Social Inclusion and Sport, Scottish Government. The Committee also took evidence on NHS Lothian’s Lean in Lothian programme from Professor James Barbour, Chief Executive, Susan Goldsmith, Director of Finance, and Jackie Sansbury, Director of Strategy Planning, NHS Lothian.

4. On 7 October 2009, the Committee took evidence from Jon Ford, Head of Health Policy and Economic Research, British Medical Association; Theresa Fyffe, Director, Royal College of Nursing Scotland, and John Gallacher, Regional Organiser and Secretary, UNISON. The Committee also took evidence from Tim Davison, Chief Executive, NHS Lanarkshire, and Malcolm Iredale, Director of Finance, NHS Highland, on how well resource transfer from NHS to councils for community services relevant to shifting the balance of care to the community, with a particular focus on older people, is planned and accounted for.

5. Finally, on 28 October 2009, the Committee took evidence from Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing (“the Cabinet Secretary”), who was accompanied by Kevin Woods, the Director-General Health, John Matheson, Director of Health Finance, and Liz Hunter, Director of Equalities, Social Inclusion and Sport, Scottish Government.

8. Two important cost pressures facing NHS boards are increases in pay and in general prices. In oral evidence to the Committee, the Cabinet Secretary gave an estimate of increases to come in 2010‑11—

9. These figures were based on previously agreed pay awards (with estimates for other awards) and the UK Treasury estimate of the GDP deflator, so they can be accepted as comparatively robust estimates although NHS inflation has tended to exceed ‘headline’ inflation in the past.

10. The Committee is also aware of a number of other sources of cost pressures, as follows—

11. Boards also face a variety of other pressures that cannot be readily avoided, including—

12. In addition, many NHS boards will have started service improvements several years ago to be implemented over a number of years. Some of these, such as new capital projects, may be very difficult to mothball until more money is available.

13. The Committee also received written evidence from BMA Scotland advising that changes in the demographics of the population and changes in technology require additional funding of nearly 1.5% per annum. This seems to be the same order of magnitude as the estimate of funding increase for an ageing population suggested by the King’s Fund and the Institute for Fiscal Studies (IFS).⁸ Overall, the King’s Fund and IFS report estimates that, in England, productivity gains of 3.4 to 7.4% will be required in 2011-2017 to fill the ‘funding gap’ between budgets and likely cost pressures.

14. The Committee believes that NHS boards will be under considerable financial pressure in 2010-11. The Committee recommends that the Scottish Government undertake further analysis of the extent and sources of cost pressures in the system and place this analysis in the public domain. Some sources of cost pressure are unavoidable but others stem from decisions made at national level that the Government either controls or can influence. Examples include (but are not confined to) the number and challenge of new HEAT targets; the standards set and pace of change in the new Quality Strategy, and the number and cost implications of SIGN guidelines issued per year.

15. The Committee is concerned that, although it appears to have been possible to estimate a cost for equal pay claims in local government, this has not been possible for the NHS. The concern is that, if cases are settled, NHS boards will face costs that they have not budgeted for. The Committee recommends that the Scottish Government put an estimate in the public domain using the same method as that underpinning the local government figure.

16. NHS boards are charged with making 2% efficiency savings per year and, in the light of the evidence on cost pressures, the Committee believes that this will be the minimum requirement for 2010-11.

17. The Committee notes the figures made public by the Scottish Government for efficiency savings, including £610m for the three years to 2007-08 in Audit Scotland’s report Financial Overview of the NHS in Scotland 2007/08⁹. The Cabinet Secretary for Health and Wellbeing wrote to the Committee on 16 October 2009 with notification of £203m of efficiency savings in 2008-09. The presentation of the data in that letter was aggregated at NHS board level.

18. The Committee naturally welcomes efforts to provide a service at the same or higher level of quality for the patient but at a lower cost to the taxpayer. However, the Committee pursued two principal lines of inquiry in relation to efficiency savings figures: the presentation of aggregated data, i.e. combining recurring and non-recurring savings, and verification of the data.

19. In relation to the presentation of aggregated data, the Director-General Health stated that the extent to which boards met their efficient government targets on a recurring basis was one of the areas that was examined closely in discussions with boards at the annual reviews, chaired by the Cabinet Secretary. He argued that non-recurring opportunities were important and should not be disregarded.¹⁰

21. It is not clear how the Scottish Government verifies the savings made, especially by NHS boards. This has many dimensions, some of the most important being—

22. Furthermore, it is unclear how resources released by efficiency savings are used, i.e. to which services they are reallocated. This is particularly an issue for cash-releasing savings, which could be allocated to a broad range of services.

24. During the evidence session with the Cabinet Secretary, the Committee sought reassurance about the methods used to verify the savings made. In response, the Cabinet Secretary explained that it is not Audit Scotland’s role to go through the savings line by line to verify them—

25. The Cabinet Secretary went on to add that the mechanism that NHS boards use to provide their own assurances on efficiency savings had been “approved and agreed” by Audit Scotland. She also stated that she was satisfied that the process in place provided the assurance on efficiency savings that people had a right to expect.¹⁴

26. On further checking, the Committee was able to establish the existence of the annual publication The Efficiency Outturn Report on the Scottish Government’s website, in which the Director-General Health signed a statement including the following—

27. NHS boards supply the Scottish Government with “a summary of supporting evidence”¹⁶ to verify their savings. This, however, does not appear to be made public.

28. The Committee notes the Scottish Government’s explanation of the process by which the integrity of stated efficiency savings is authorised by accountable officers. However, given that the accountable officers are also part of the process responsible for delivering efficiency savings, the Committee remains uncomfortable that efficiency savings figures appear not to be independently verified. This is of more than passing interest, since it seems likely that most – if not all – NHS boards will need to make more than the national 2% target in 2010-11 to meet spending commitments.

29. The Committee welcomes the national Efficiency and Productivity initiative if it spreads best practice and brings greater transparency. However, the pressing need is for clarity and transparency of the savings counted as being cash-releasing by NHS boards. The Committee recommends that, from now on, NHS boards should make public a description of each type of saving, how it was achieved, the amount saved and how the board checked that the service to patients did not suffer as a result and that savings were used to the clear benefit of patients.

30. The Committee raised the reduction in the nurses training budget with the Cabinet Secretary with some concern, reflecting the views of the Royal College of Nursing (RCN) and UNISON among others. However, the Cabinet Secretary explained the position as follows—

31. This gave the Committee reassurance that the reduction in the budget did not reflect a straightforward cut in training places; however, the Committee requests the Cabinet Secretary to update them on this item when further information is available. The Committee is alert to, and concerned by, any changes that affect training programmes for staff, and the Committee would wish to see these protected in future years.

32. The Committee noted the estimate that distinction awards may cost £30m in 2010-11, an increase of £2m. The Committee notes the Scottish Government’s evidence submitted to the Doctors’ and Dentists’ Review Body (“DDRB”) that the increase should be 0% in 2010-11 to reflect the difficult financial situation for public finances in general.

33. The Committee believes that increasing spending on distinction awards at a time when so little new money is available sends the wrong signals to doctors, the NHS and the public. The Committee recommends that the Scottish Government adhere to its stated position, that spending on distinction awards should not increase. The Committee would support ignoring the DDRB recommendation if implementing it would increase the overall cost of distinction awards. More generally, the Committee is concerned about the apparent mismatch between the stated policy objectives of the distinction awards scheme and the way it is put into practice. The Committee will return to this issue as a separate matter following scrutiny of the draft budget for 2010-11.

34. The Committee records its support for schemes that it classifies as telehealth and e-health, noting their potential to produce time-releasing savings and possibly cash-releasing savings. However, it notes that the way that the costs of these schemes are classified has been the cause of considerable confusion and uncertainty. A particular concern is that elements of spending are included under the budget line for capital but that this is not disaggregated, so it is not possible to see how spending on telehealth is changing. The Committee recommends that these two items – telehealth and e-health – be given their own separate budget lines to clarify the differences and amounts allocated to each one.

35. The concern over spending on telehealth and e-health also brought to light the lack of detail relating to the line for capital spending. The Committee requests that the Scottish Government provide further detail of what this money is to be allocated for in future draft budget documents.

36. Spending on GMS increased by around £30m in previous years, and the Committee assumes a comparable figure has been budgeted for and included under Miscellaneous Other Services. The position with GDS is slightly more complicated: no increase has yet been agreed for GDS in 2009-10 or 2010-11. The last definite figure to appear in a draft budget for this line was for 2006-07, when the figure was £313m. At that time, the planned spend for 2007-08 was £354.5m, but this figure is still being included in the current document as the indicative amount for 2010-11. This means that increases for 2008-09, 2009-10 and 2010-11 will have to be included. The last uplift was of £49m (difference between 2005-06 and 2006-07) and it may be unlikely that this will have been sustained over this period. The Committee recommends that the Scottish Government’s submission to the DDRB be used to produce an estimate of the increase in these budgets if the Government’s position were accepted.

37. The Scottish Government explained that the reduction in the health screening budget was attributable to some start-up costs to screening programmes – presumably incurred in the current financial year – being non-recurring and hence the budget appeared to fall.

38. The budget for this item has also fallen. The Scottish Government explained this was because expenditure to deliver a manifesto commitment of health checks for those reaching 40 years of age had been achieved with a lower budget than anticipated. In addition, separate savings had been achieved because, in previous years, the budget available for flu vaccine for unpaid carers had not been fully used, so the budget was now being adjusted to reflect this. The Committee has some concerns on this latter point since there may be far greater awareness of the need for flu vaccination in future years as a result of the media coverage of the flu outbreak this year and demand may, therefore, increase.

39. The Committee noted that this budget had fallen substantially from the previous year, but was reassured that this was because funds had been allocated to NHS boards rather than being allocated centrally on a non-recurring basis.

40. A characteristic of draft budgets for the health portfolio has been the high level of spending that is earmarked for NHS boards. At this stage, NHS boards have not been notified of their final allocation and hence the Committee is unable to scrutinise how this money will be spent, except in terms of (i) stated national priorities, and (ii) targets set for NHS boards.

41. It is notable that the draft budget contains no links to any other policy document or set of targets. In terms of planning, this raises a concern about whether spending and target-setting decisions are sufficiently closely linked. In terms of transparency, members of the public would not know other policy documents and targets even existed.

42. In response to concerns raised by the Committee, the Director-General for Health set out planned changes to HEAT targets for 2010-11, as well as the ways in which spending on national and central functions (as outlined in the draft budget) could be linked.

43. To try to understand the links between spending and performance against HEAT targets in the past, the Committee considered the document NHSScotland Chief Executive’s Annual Report 2007/08¹⁸, the most recent overview of performance available. This showed—

45. Even some targets that were described as “met” in the annual report can involve some people not receiving the service specified (for example, some waiting time targets). In addition, targets described as “met” may not be sustained (teenage pregnancy rate was at target level in 2001 but has risen since then) or may not have been achieved by all NHS boards since the judgement about whether a target is met was based on national averages. The Director-General for Health acknowledged this in response to questioning from the Committee about sickness absence rates: asked about the performance of NHS boards against the target – in particular, the Scottish Ambulance Service’s rate of 5.4%, NHS 24’s rate of 6.9% and the state hospital at Carstairs’ rate of over 6% – he said—

46. However, a target that was not met or is not on course has no obvious bearing on future budget plans. Part of the reason for some of the targets not being met may be that they were not sufficiently integrated with budget decisions and sufficient resource was not set aside to deliver them. It was also not evident from the Director-General Health’s account of changes to HEAT targets for the coming year that the cost implications of achieving a target was taken into account when setting them. The constant challenge to NHS boards appears to be that they have been given enough and so should be able to cope. In fact, the failure to meet targets such as reductions in sickness absence and the problems reducing repeat emergency admissions in older people show that these may well be much larger problems than was anticipated.

47. The Committee thus has concerns that the link between spending and targets has not been sufficiently clear in the past. The moves to link national spending to HEAT targets are welcome, but some links are stronger than others and, where spending cannot be readily linked to a target, it is unclear whether this indicates inappropriate spending or – more simply – spending in an area that is important but does not have a target. The Committee would not welcome targets for every aspect of the NHS simply to justify existing spending patterns.

48. The Committee studied the allocations made to central and national functions in Table 3.03 of the draft budget. However, the text accompanying the table often did not fully explain changes. As a result, some concern was caused to the Committee and to witnesses who gave evidence to the Committee. In response to questioning, the Cabinet Secretary was able to provide clear explanations of the reasons for the changes, and it would have been helpful if this level of clarity could have been provided in the text of the draft budget document itself.

49. The Committee is concerned by the lack of evidence that budgeting and target-setting are integrated processes within the Scottish Government. Firstly, targets are themselves ‘cost drivers’ so introducing new targets and setting the level and timescale for the target will have cost consequences for those charged with taking action to meet the target that does not appear to have been recognised. There will also be consequent opportunity costs for services in respect of which targets are not set. Second, past failure to meet targets (or to address targets that are not on track to be met) does not appear to result in any new financial commitments to address the issue: for example, the sickness absence target was not met but the budget for 2010-11 does not contain any commitment to devote resources to addressing the problem.

50. There is a general frustration that the draft budget is simply a spending plan for national functions plus an allocation to NHS boards with devolved responsibility. The Committee estimates that, to understand the links between the budget and targets as well as the policy context, a lay-reader would, as a minimum, have to consult a minimum of six other documents and visit four different websites.²¹ However, first of all, he/she would have to know about the existence of these sources of information since none of them are referenced in the draft budget document.

51. In written evidence, the RCN was critical of the presentation of the draft budget document. Calling for clearer draft budgets in the future, the RCN stated that—

52. The Committee found several of the changes to be puzzling and causes for concern. Under questioning, the Cabinet Secretary was able to provide clear explanations of the reasons for the changes, but these should have been provided in the draft budget document itself.

54. The Committee recognises that there are limitations on the draft budget document imposed by the format for the document. However, it has the following recommendations—

55. Earlier this year, the Committee published its report on pathways into sport and physical activity. One of the findings from that report was that there was strong scientific evidence that physical activity could protect against many of Scotland’s leading chronic diseases, as well as making clear the role that physical activity could play in promoting positive mental health and well-being. In its report, the Committee made a number of recommendations all designed to encourage lifelong physical activity for the whole population.

56. The Committee reiterates its view that it is important that funding for elite sport – including the funding of the hosting of the Commonwealth Games in Glasgow in 2014 – should not be at the expense of funding for grassroots sport and other physical activity. That said, the Committee recognises that local authorities are responsible for 90% of public expenditure on sport. In the current public expenditure climate, all local authorities will be faced with making difficult prioritisation decisions. The Committee is concerned that, historically, the provision of sports facilities has tended to suffer when there have been severe pressures on public expenditure. Given the long-term public-health benefits that physical activity creates, the Committee recommends that local authorities take the long view when it comes to making budgetary choices in the next financial year.

57. The Committee is also concerned about the continuing deficit faced by grassroots and elite sports organisations as a result of the way in which National Lottery proceeds are being used to fund the regeneration costs associated with the London 2012 Olympic Games. The Committee recommends that the Scottish Government continue to make efforts to ensure that Scotland receives a fair distribution of lottery funding.

58. In keeping with previous years, a large proportion of health spending is unavailable to the Committee for scrutiny: of the budget for the health portfolio, 75% will be allocated to territorial and special NHS boards. The draft budget presents no information on how this substantial amount of money will be allocated. The Committee therefore cannot examine these allocations as part of its scrutiny of the draft budget for health and therefore no assessment can be made about the allocation of these funds, which amount to around a quarter of total Scottish Government spending.

59. The Committee is in broad agreement with the proposed allocation for Health and Sport outlined in the draft budget for 2010-11. However, specific points of concern remain, notably—

60. Of equal concern to the Committee is the amount of work required to satisfy itself that changes in the budget have a reasonable and acceptable explanation. The Committee acknowledges there are limits on the length of the draft budget document but recommends that the Scottish Government engage in discussion to provide a more detailed supplementary document alongside future budgets that will assist the Committee with its budget scrutiny in future years.

61. As part of this process, the Committee would also wish to see the Scottish Government set the draft budget in context with other plans, policies and targets. At present, the draft budget is simply a spending statement for central and national functions, which make up a relatively small slice of the health and sport allocation.

62. The Finance Committee asked for particular comments on whether the draft budget showed evidence of long-term thinking, which the Committee raised with the Cabinet Secretary. In response, she listed a number of long-term targets and policies. The Committee welcomes these and notes that there is a broad consensus between political parties on the desired strategic direction of the health service, such as a focus on healthy life expectancy and shifting the balance of care, which helps with long-term planning. However, the items listed by the Cabinet Secretary did not relate directly to the draft budget; this reinforces the Committee’s recommendation to see integrated thinking and planning to encompass budgets and targets.

63. The Finance Committee also asked for particular comments on the sustainability of the draft budget. The Committee notes that the last decade has seen substantial increases in funding for the health service. The current ability to make efficiency savings may, in part, reflect the ‘bedding down’ of some of this spending, but it is difficult to judge what potential for further savings exists. This reinforces the Committee’s recommendation that efficiency savings be made more transparent because a concern is that, at some point, savings will be made that will affect the quality of service for patients. At present, there are no transparent means of checking this and there is a danger that ‘savings’ affecting quality will only come to light when patients suffer. Everyone concerned would prefer a monitoring system that ensures that this does not happen.

64. Turning to contingency planning, the main issue facing the health service at present is the H1N1 flu outbreak. The health service has been able to put in place contingency plans which everyone concerned hopes will not be tested; making a judgement about their adequacy would require more detailed evidence than is available at present. In terms of the broader picture, the ‘safety valve’ for all pressures created when costs exceed funding is efficiency savings by NHS boards. As stated above, the Committee agrees there is scope for further local savings but is concerned that at some point quality will suffer and there are no effective safeguards against this.

65. The Committee wished to pursue the issue of how the challenging financial situation would impact on the rate of change in the balance of care – considering the balance between both hospital-based care and community-based care, and health care and social care (largely provided by local government).

66. The NHS has a mixed record on shifting the balance of care. On a positive note, the NHS met its HEAT targets to prevent anyone waiting longer than six weeks to be discharged from hospital to an appropriate setting. On the other hand, the current HEAT target on reducing repeated emergency admissions among older people is in danger of not being met, suggesting a potential shortfall in services outside of hospital that can prevent the need for an admission or provide alternatives to an admission. The Committee also has concerns about whether money reallocated from NHS boards to local government in resource transfer (estimated as £330m across the last 10-15 years in Scotland according to the Chief Executive of NHS Lanarkshire²²) could be traced and spent on the types of service for which it was intended.

67. When it took evidence on these areas, the Committee received conflicting evidence on progress in shifting the balance of care. On the one hand, NHS boards reported that they were clear about the need for change and considerable work was going on. For example, the Chief Executive of NHS Lanarkshire said—

69. These witnesses were able to supply detailed accounts of the steps in the discussion and planning process in which they were currently engaged. Set against this, national organisations such as Audit Scotland and the RCN were more sceptical.

70. Audit Scotland said that there was “no evidence of a change in the balance of health expenditure to match the move towards more community-based care.”²⁵

71. Similarly, the RCN made the point that, although NHS boards (and local government) are responsible for transferring the balance of care, the budget is at national level so it is difficult to see evidence that the environment is being created.²⁶ This was confirmed by the Director-General Health—

72. The RCN stated that it had “seen little evidence” that the balance of care was being changed in practice. The RCN reported in written evidence that it had collated local single outcome agreements and that these show “vast variation” in the priority given to local government spending that has consequences for the NHS.

73. UNISON observed that there was no national strategy for resource transfer between health boards and local authorities across Scotland: each had the power to allocate budgets to its own priorities, with local authorities directly accountable to their local electorates for their spending priorities. According to UNISON, where it worked well, it was due to strategic planning frameworks at senior manager level and close operational liaison between social work area teams and community health partnerships. On the understanding that it was common for NHS boards and local authorities to have an agreed ‘baseline’ of beds and an agreement that any changes to those numbers will form the basis of a resource transfer discussion, UNISON expressed the view that, in principle, neither party should plan changes to provision that have a consequential effect on the other without wider discussion/involvement. UNISON believed that, if a new plan required, for example, more social services support, the cost should be factored into the business case/agreement but, if the new model simply replaces one type of NHS care with another and does not require extra social services input, then there should be no case for a resource transfer. This principle would apply to local authority plans as well.

74. It seems that local staff are devoting considerable time and effort to planning the implementation of the policy but such progress as is made is not being reflected in data on performance that is in the public domain.

75. One of the simplest measures of the shift in the balance of care is in terms of budgets but the Committee heard from the Chief Executive of NHS Lanarkshire that transfer of budgets may not be an appropriate metric for progress: he emphasised steps to improve the joint management of existing resources by the NHS and local government. However, this raises the question of how the Committee, the Parliament and taxpayers can be reassured that tangible differences are being made to the services to patients when one of the only available measures – budgets – is not accepted as valid by one of the key participants.

76. The Committee heard recent progress made on the first step of the Integrated Resource Framework was in estimating activity, cost and variation in health and adult social care. Using these data, the Director-General Health wrote to the Committee to report that “approximately £4.5bn was spent on health and social care for people aged 65 and over in Scotland during 2007/08.”²⁸ However, it does not appear that the data are in the public domain so the Committee was not able to use them to inform their budget scrutiny.

77. The Committee was able to identify the Scottish Government’s “Shifting the Balance of Care” website²⁹, which includes evidence on the Improvement Framework. However, this was not referred to in the draft budget and a general reader of that document would have been unaware of its existence. The website includes a “Question and Answer” document on the Framework, which, under the heading “When will it be available?”, states—

“The development work started in April 2008. Progress in mapping resource varies across partnerships, with each progressing at their own pace.”³⁰

78. The Committee heard that, as a progression from ‘mapping’ current resource use, the focus has now shifted to moving resources around. The Committee notes that the planning process seems to be on-going and no timescale was given on when it would produce results. The Committee was pleased to hear from the Director-General Health that future HEAT targets for NHS boards will be modified to reflect single outcome agreements. However, it is a matter of concern that the only two existing targets are for reducing delayed discharges (which was met some time ago) and reducing repeated emergency admissions in older people (which is in danger of not being met). This suggests that, while there are some achievements, they are not fast enough.

79. The Committee’s concern is that good intentions are not always translating into good deeds. When challenged to provide one local example of change, one witness cited the move out of long-stay psychiatry and learning disability hospitals³¹ – this policy is some twenty years old and required substantial national bridging finance.

80. The lack of bridging finance at present seems to be a brake on the rate of change. Witnesses accepted this was unlikely to change but did not appear to have concrete alternative proposals. One said—

81. Witnesses spoke of needing to be innovative and imaginative and “disinvesting some resources in the short-term”.³³ The Committee was unclear what this meant in practice, and is concerned that attempts will be made to close some services to make savings so that other services will be put in place.

82. During the evidence session with the Cabinet Secretary, the Committee also asked about the former Joint Future programme, which promoted working together between health boards and local authority social care services. The Committee raised the point that Joint Future was not referred to in budget documents nor in any of the correspondence on HEAT targets and sought reassurance that the programme had not “disappeared off the map”. In response, the Cabinet Secretary explained that “Improvement and Support of the NHS” is the relevant budget line—

83. The Cabinet Secretary acknowledged that the joint improvement team had subsumed much of that national programme and the Director-General Health explained that the joint improvement team’s objective was to support partnership working through a range of projects—

The balance between hospital care and primary care (including community-based services)

84. The Committee raised with the Cabinet Secretary the budget arrangements for shifting the balance of care from acute to primary care insofar as ensuring that the appropriate services are available in the primary care sector so that people can be moved out of the acute sector. Effectively, that means that services in both sectors must be funded at the same time. Asked whether the £28m of additional money for this purpose was sufficient to enable primary care services to be pump-primed in order to deal with the change in the balance of care, the Cabinet Secretary responded—

85. The Committee went on to ask the Cabinet Secretary whether such pump-priming costs incurred by health boards in respect of shifting the balance of care would be protected from efficiency savings. The Cabinet Secretary suggested that NHS boards would not be tempted to seek to make efficiency savings from those costs—

86. The Cabinet Secretary also highlighted that, although NHS boards must spend their resource allocations in a way that supports the shift in the balance of care, there is also a budget line for improvement and support of the NHS. This budget line provides “national funding that can be allocated to boards to help with redesign work.”³⁸

87. Turning to redesign of services, the Committee asked whether the Cabinet Secretary was satisfied that there was enough scope for the mechanisms to work efficiently. In response, she emphasised the scale of the shifting the balance of care exercise—

88. Finally, the Cabinet Secretary pointed out that it is a feature of annual reviews that boards must show how they are achieving a shift in the balance of care. She acknowledged that this work is still in progress—

89. The Committee is concerned that, as the Joint Futures programme has now been subsumed within the joint improvement team, its profile may have diminished.

90. The Committee welcomes the stated amount of effort being devoted to improving the joint management of resources. However, such plans as are in the public domain do not have a timetable or measurable targets for progress. There is no evidence of integration with the draft budget document causing the Committee concern that the process will simply drag on.

91. Finally, the Committee has concerns about the transparency of funds transferred to local authorities in previous years. These funds cannot be tracked and therefore the Committee has no assurance that these have been spent appropriately.

HEAT targets missed or in danger of not being met, as referred to in paragraph 44, include—

“Health Boards to achieve a sickness absence rate of 4 per cent by 31 March 2008.”

“To respond to 75 per cent of Category A calls within 8 minutes in Quarter 4 of 2007/08 (mainland Health Boards only).”

“The maximum wait from urgent referral to treatment for all cancers is 2 months; women who have breast cancer and need urgent treatment will get it within one month where appropriate.”

“By 2008/09 … reduce the proportion of older people (aged 65+) who are admitted as emergency inpatients two or more times in a single year by 20 per cent compared with 2004/05, and reduce by 10 per cent emergency inpatient bed days.”

“To reduce health inequalities by increasing the rate of improvement for the most deprived communities by 15 per cent across a range of indicators including Coronary Heart Disease (CHD), cancer, adult smoking, smoking during pregnancy, teenage pregnancy and suicides in young people. Pregnancy rate in 13-15 year olds to fall to 6.8 per 1000 by 2010.”

Scottish Government (2008), Efficient Government – Efficiency Outturn Report for 2007 - 2008. Scottish Government. Available at: www.scotland.gov.uk/Publications/2008/10/Outturn2008 [Accessed 24 November 2009]

Scottish Government (2009), NHSScotland Efficiency and Productivity Programme: Delivery Framework. Scottish Government. Available at: www.scotland.gov.uk/Publications/2009/06/22125603/0 [Accessed 24 November 2009]

1. Last year the Justice Committee concentrated its scrutiny of the draft budget on prisons spending and followed up issues raised previously in relation to police spending.

2. This year the Committee initially decided that its scrutiny would concentrate on funding for community penalties, as an extension of its ongoing consideration of the Criminal Justice and Licensing (Scotland) Bill. However, following media reports over the summer, the Committee agreed also to consider police funding again, with particular reference to Strathclyde Police, in light of its reported expected deficit.

3. 2010-11 will be the third year of the 2007 Spending Review (SR 2007). As there was no UK Spending Review in 2009, the starting point for the 2010-11 budget is the spending plans published in 2007 and modified thereafter in budget debates and negotiation and the knock-on effects of changes made by the Scottish Government in 2008-09 and 2009-10. These changes include the re-profiling of capital expenditure totalling £347 million from 2010-11 into expenditure for 2008-09 and 2009-10.

4. Overall the Scottish budget has been reduced by around £500 million¹ by comparison with the budget for the year anticipated in SR 2007 (the Justice share of this reduction from the 2007 plans is £13.7 million spread across a number of areas.²) At the same time, the 2010-11 budget has seen a small increase compared with 2009-10 as a result of Barnett consequentials and planned total managed expenditure by the Scottish Government will increase by £279 million in cash terms compared with 2009-10. Justice spending, in cash terms, is planned to increase by 3.1% or 1.5% in real terms compared with 2009-10. Had there been no re-profiling, the cash increase would have been around £626 million.³

6. There are a number of changes to planned police spending as set out in this year’s Draft Budget compared with the plans set out last year for 2010-11. The total allocated to police central government spending has been increased by £84.6 million, whilst the level of police grant has been reduced by £33.3 million. The Draft Budget states that these changes are a result of some additional monies for police officers and police pensions, and some transfers of funds.

7. The Committee recognises that the Scottish Government’s expenditure plans for 2010-11 provide the resources to fund the commitment to have an additional 1,000 police officers, beyond the 2007 establishment, in post by March 2011. The Committee welcomes the provision now being made for the cost of police pensions both in the current year and in the plans for 2010-11, a matter which had previously been of concern to the Committee.

8. The Committee also recognises that as a consequence of the Concordat arrangements between the Scottish Government and local government, it remains to be seen whether local authorities will, when setting their budgets, decide⁵ to maintain in full their historical share of overall police funding.

9. Both the Association of Chief Police Officers in Scotland (ACPOS) and Strathclyde Police said that it was going to be a challenge to sustain the increased numbers of officers throughout the financial year, particularly as it was not yet known what level of funding local authorities would provide for each police force. However, their view was that if the estimates were correct and forces receive the funding they want, they should be able to maintain numbers. The Committee is aware that many police forces receive direct funding from local authorities for extra officers and that clarification is required from local authorities of the extent to which such funded posts would be retained.

10. The main concern for ACPOS however was that although there was still a separate budget line for police grant, the removal of ring-fenced grant-aided expenditure had created uncertainty about whether each police force would have to negotiate with the local authority for its share of the budget.

11. The Chief Constable of Strathclyde Police, Stephen House, said that despite the additional Scottish Government funding, Strathclyde Police was facing a potential budget deficit in 2010-11. The Committee noted that a best-case scenario of a deficit of £12.5 million and a worst-case scenario of a deficit of £34 million had been reported. In his evidence, Stephen House updated the Committee saying that “As we get closer to 2010-11, we know that we are much nearer to the best-case scenario, but the deficit will still be around £16 million to £18 million.”⁶

12. One of the reasons given for the anticipated shortfall in Strathclyde was that the police expect that the 12 constituent local authorities would find it difficult to maintain their current level of funding to Strathclyde police authority. According to Stephen House, however, the main reason for the shortfall was that the budget was not keeping up with the nationally agreed pay deal. He noted that 90% of police funding was in respect of people and that savings in a police context quickly come to be about where numbers of people can be reduced. He said that reducing police officer numbers would be a last resort if cuts had to be made and that should he find himself in the situation where cuts were required, support staff numbers would be the most likely to be affected.⁷

13. The Committee considers that there is a lack of clarity as to whether Strathclyde Police’s anticipated shortfall is due to structural issues or a historical underfunding of pay settlements and notes that pay will continue to be a key pressure on police resources in coming years.

14. In relation to efficiency savings, ACPOS told the Committee that although there was no specific efficiency savings target set for the police, forces had agreed to seek the same 2% cash efficiency savings as were being asked of local government.⁸ ACPOS advised that the police service had exceeded the efficiency savings aimed for and that improved efficiency had helped the police meet the challenge of additional tasks which they had been required to take on in recent years, such as the management of sex offenders and violent offenders.

15. ACPOS warned, however, that there was now an element of diminishing returns in areas where significant efficiencies have been identified in previous years and that the scope for making further efficiency savings had as a result, become more limited. Allan MacLeod, for Strathclyde Police, summarised the position by saying that “if efficiency savings must increasingly, as we expect, be applied to close future budget deficits, that must have an implication for staff numbers.”⁹

16. In relation to reducing staff costs, Stephen House noted also that cost savings were becoming more difficult to realise through the further civilianisation of posts. He suggested that the creation of more civilian posts would require more rather than less money “because police officers offer a flexibility of deployment that police staff do not.”¹⁰ Unison however took the view that further civilianisation was indeed possible and that there was scope for this as a means of reducing pressure on police budgets and drew attention to the variations across Scottish police forces in the ratios of uniformed to civilian staff.¹¹

17. The Committee is aware that discussions between police forces and local authorities on funding are taking place and welcomes the acknowledgement by COSLA that although local authorities have limited resources they recognise that law and order and community safety issues are crucial and that the police service plays a central role in that regard. The Committee notes the caveat expressed by Councillor McGuigan who said—

18. The Cabinet Secretary for Justice said that the Scottish Government had given priority to police funding and that as well as funding 1,000 additional officers, the necessary resources for police pay settlements up to March 2011 had been provided, as had money for pensions. In response to the ACPOS concern about the move away from ring-fencing of money provided to local authorities, and the possible impact on police authorities, the Cabinet Secretary stated that funding for police current expenditure through General Revenue Grant had never been ring-fenced and that the arrangements in this regard had not changed. The Cabinet Secretary applauded the achievement of police forces in making efficiency savings and expressed confidence that they would continue to rise to the challenge.

19. The Committee recognises and welcomes the Scottish Government’s provision for additional police officers, for police pensions and for pay settlements up to the end of the financial year 2010-11. The Committee hopes that local authorities will continue to provide their customary share of police funding to ensure that police officer numbers and the quality of the police service are maintained. The Committee urges the Cabinet Secretary to work jointly with local government, within the terms of the Concordat, to ensure that any obstacles which may arise in this regard are quickly addressed.

20. The Committee also welcomes the efficiency savings made by the police service over a number of years, as well as such further progress as may be made on civilianisation in order to free police officers for front line duties. The Committee takes note of the concerns expressed by ACPOS about the extent to which efficiency savings might be relied upon in the future to make good any deficits in police budgets and looks to the Scottish Government to take those concerns into account when bringing forward its spending proposals for 2011-12.

21. Spending on community justice services is planned to decrease from £23.2 million in 2009-10 to £22.8 million (-1.7%) in 2010-11, equating to a 3.2% real terms decrease. The level of criminal justice social work grant provided to local authorities is planned to remain unchanged from 2009-10 to 2010-11, equating to a 1.5% real terms decrease.

22. The Committee notes that although the Scottish Government has a clearly stated policy aspiration to, where appropriate, place more reliance on community-based disposals instead of custodial sentences, the specific grant to local authorities for criminal justice social work in 2010-11 is being held at the current year’s level of £86.5 million – representing a real terms cut.

24. In the current year an additional £3.5 million is being provided to Community Justice Authorities (CJAs) to improve the immediacy and visibility of community service. The Cabinet Secretary confirmed that it was his intention to increase these additional monies to £6 million in 2010-11 and to fund this from underspend in the Justice portfolio. The necessary adjustments for 2009-10 are to be made in the Autumn budget revisions.

25. Ruth Ritchie, of the Scottish Government Finance Directorate, explained that the additional monies were expected to come from an allocation of funds presently marked “CJA Local Initiatives” and “Community Penalty Reviews.” Together these funds came to nearly £7 million and covered initiatives and pilots which were considered but not developed.¹⁴

26. Clearly the additional funds are and have been welcomed. The Committee was told by the Association of Directors of Social Work (ADSW) that the monies had been spent in slightly different ways across the 32 local authorities, and by the Convention of Scottish Local Authorities (COSLA) that the additional resources had provided “an opportunity to deal effectively with the backlog and to appoint people who were more professionally versed and who could bring a greater quality to some projects.”¹⁵ An audit of community justice services is planned for November this year which should, it is hoped, show significant improvements in performance and point those involved in the direction of how best to target the further additional monies.

27. ADSW raised a concern about current funding and about what they saw as a lack of consensus on the actual costs of services. ADSW stated that it based its assumptions on unit costs, arrived at by dividing the available amount of monies each year by the number of new orders in any given year. It noted that this did not provide an accurate reflection of the actual cost of a service and therefore indicated that it would be supportive of any work undertaken to examine, on a more accurate basis, the cost of basic services.¹⁶

28. Both COSLA and Unison observed that resourcing was an issue for the effective delivery of criminal justice social work services, but neither argued that the specific grant to local authorities of £86.5 million in 2010-11 was in itself inadequate, despite its representing a real terms cut compared with 2009-10. Unison said that a tightening of resources would be most likely to have a qualitative, if not a quantitative, effect on service delivery and this was echoed by COSLA.

29. The Committee understands that changes to published spending figures, as a result of switching expenditure between programmes within the portfolio in the current year, must await the Autumn budget revisions. However, the Committee considers it inconsistent with the principle of budget transparency that there is no detail of where the monies will be found in the budget document for the following year to meet, what the Cabinet Secretary confirmed, was a specific expenditure commitment. The Committee looks forward to seeing, in due course, a clear statement of the proposed switch in resources in the Budget Bill.

30. Although it is recognised that the outcome of a future Spending Review cannot be anticipated, the Committee welcomes the Cabinet Secretary’s confirmation that the additional provision for Community Justice Authorities in 2010-11 will be included in the baseline on which future expenditure decisions will be founded. However the Committee is concerned that beyond this, for now, there is little evidence of substantial financial commitment by the Scottish Government to increased resources for community sentences other than on the basis of emerging underspend on other programmes. The Committee is not confident that this is an adequate platform from which to take forward a policy which envisages a greater reliance on community disposals.

31. Although the Committee did not focus its scrutiny this year on funding for fire and rescue services, Ken Ross of the Fire Brigades Union (FBU) was invited to give oral evidence as part of a panel of “frontline workers”, comprising union representatives. In his evidence, he expressed two main concerns, firstly that “there now appear to be no transparent criteria for determining Fire and Rescue Service funding” and secondly that the removal of ring-fenced funding “has resulted in guaranteed funding for Fire and Rescue Authorities no longer being assured.”¹⁷

32. The Chief Fire Officers Association Scotland (CFOAS) said however that revenue funding for fire and rescue services had never been ring-fenced and that it did not consider that the arrangements for funding had resulted in detriment to the Fire and Rescue Services.¹⁸ The Committee is aware that the CFOAS is in discussions with COSLA and the Scottish Government on the key principles which might in future inform fire capital grant distribution.

33. On the issue of efficiency savings, the FBU considered that there had been progress but that there was further scope for greater sharing of services, including recruitment and procurement, and corporate support. The CFOAS noted that a new shared procurement service “Fire Scotland” would be formally established in November 2009, and that financial savings had already been achieved. A project had also been established to identify shared services initiatives across the eight fire authorities in order to improve the effectiveness of collectively delivered services and to improve efficiency. CFOAS is also exploring the scope for closer collaboration between the Scottish Fire and Rescue Services and the Scottish Ambulance Service. The Committee takes note of CFOAS’s view that, although efficiency savings had exceeded the 2008-09 target, they would become increasingly difficult to achieve.

34. As with police funding, the Committee hopes that local authorities will continue to ensure that Scotland’s Fire and Rescue Services are adequately resourced and urges the Cabinet Secretary to work jointly with local government, within the terms of the Concordat, to ensure that any obstacles which arise in that regard are quickly addressed. The Committee also urges Fire Authorities to work with CFOAS, the FBU and other partners to take forward further work on shared services and collaborative service delivery.

35. Prisons spending is planned to increase from £455.1 million in 2009-10 to £485.9 million (+6.8%) in 2010-11, equating to a 5.2% real terms increase. Most of the increase in 2010-11 is accounted for by a £28.2 million (cash terms) increase in capital spending. The amount set out in this year’s Draft Budget for prisons current spending has been reduced by 1.4% when compared with the plans set out last year for 2010-11.

36. Prison running costs are planned to increase from £271 million in 2009-10 to £272.7 million in 2010-11, an increase in cash terms of 0.6% but a decrease of £4.1 million compared with previous plans. John Speed of the Prison Officers Association (POA) expressed concern over this real terms cut in running costs at a time when prison overcrowding remains an issue despite new accommodation coming on stream.

37. The POA pointed out that there had been significant reductions in operational staffing over the past decade, while conceding that changes in the prisons estate had made strict comparisons difficult. The staffing reductions reflected efficiency savings made by the Scottish Prison Service (SPS). The POA is working with prisons management to identify where any further savings can be made, but the POA would not be able to agree to savings which could put health and safety at risk and was concerned that a further squeeze on running costs would put greater pressure on the prisons service at a time when growing prisoner numbers continued to result in overcrowding.

38. The SPS said that the Assessed Operational Limit (AOL) of Scotland’s prisons had not been reached at national level although some prisons had been close to or had breached the local AOL for short periods. The SPS confirmed that prisoner numbers are projected to continue to rise and if they do, the prisoner population would still exceed design capacity even after taking into account the new prison currently under construction at Low Moss, which is due to open in 2012.

39. The Cabinet Secretary said that the draft revenue budget for the SPS provided a cash increase of £2.6 million compared with 2009-10 and that whilst working within the running costs provided was an operational matter for the SPS, he agreed that the safety of prison officers had to be paramount. Notwithstanding this, he stated that it was important that all parts of the public sector contributed to the Government’s efficiency programme and that the SPS had an excellent record of delivering efficiency savings in partnership with the trade unions.

40. The Committee welcomes the Scottish Government’s continued commitment to fund additional capacity and to upgrade substandard accommodation, and notes the consistent progress made by the SPS in delivering efficiencies. The Committee would be concerned if the real terms reduction in running costs in 2010-11 were to put frontline staff at risk or to make it more difficult for them to engage constructively with prisoners in the delivery of rehabilitative programmes and regimes. The Scottish Government should therefore keep the running costs of the SPS under review and be willing to respond constructively to any circumstances which might lead SPS management to consider that a safe and effective service was at risk.

41. The Committee notes from the budget document, and from evidence from the Cabinet Secretary for Justice, the Scottish Government’s view that the downward revisions to the previously published plans for expenditure on certain programmes, across all Scottish spending areas, were due to cuts imposed by the UK Government.

42. The Committee recognises that these revisions can be seen in the context of a tightening of public expenditure at UK level in response to the global financial crisis, and also that the downward adjustment of the Scottish budget compared with previously published plans reflects both the application in the normal way of formula consequentials through the Barnett arrangements, and the effects of the re-profiling of capital expenditure between 2010-11 and the previous two years.

43. The Committee also observes that, despite the revisions to planned expenditure for 2010-11, the Scottish Government is maintaining its commitments on the funding of police numbers and Police and Fire and Rescue Service pensions. The Committee recognises that some additional monies are being provided for community sentences both in 2009-10 and 2010-11 but looking further ahead, the Committee is concerned about the prospects for public expenditure in the years ahead, given the UK fiscal context and the remedial measures which seem likely to be required.

44. The Committee considers it of utmost importance that the additional funding for Police, Fire and Rescue Services, and for improvements in community sentences, is fully baselined and protected in the next spending review, and that future spending decisions ensure that the Justice portfolio continues to be resourced at a level that adequately protects and safeguards the public as well as those working in our police, fire and rescue, and prison services.

Decision on taking business in private: The Committee agreed to take item 3 in private.

Draft Budget Scrutiny 2010-11 (in private): The Committee received a briefing from its budget adviser, Eddie Frizzell, on the Scottish Government's Draft Budget 2010-11. It agreed, subject to witnesses' availability, to take oral evidence (1) on funding for community penalties, from the Convention of Scottish Local Authorities, the Association of Directors of Social Work and Victim Support Scotland; (2) on police budgets and funding, from the Association of Chief Police Officers in Scotland, Strathclyde Police and Strathclyde Joint Police Board; (3) from trade unions and organisations representing front-line workers in the prisons, police and fire services; and (4) from the Cabinet Secretary for Justice and Scottish Government officials. It also agreed to invite written evidence from these organisations, community justice authorities, the Scottish Prison Service, the Crown Office and Procurator Fiscal Service and the Scottish Court Service.

Draft Budget Scrutiny 2010-11: The Committee took evidence on the Scottish Government’s Draft Budget 2010-11 from—

Decisions on taking business in private: The Committee agreed to take items 6 and 7 in private.

Draft Budget Scrutiny 2010-11: The Committee took evidence on the Scottish Government's Draft Budget 2010-11 from—

Draft Budget Scrutiny 2010-11 (in private): The Committee considered the main themes arising from the evidence in order to inform the drafting of its report to the Finance Committee.

Draft Budget Scrutiny 2010-11 (in private): The Committee considered a draft report to the Finance Committee on the Scottish Government's Draft Budget 2010-11 and agreed to consider a revised draft at its next meeting.

Draft Budget Scrutiny 2010-11 (in private): The Committee considered and agreed its report to the Finance Committee on the Scottish Government's Draft Budget 2010-11. In so doing, various changes were agreed to, one by division.

Record of division in private: In relation to paragraph 8 of the report, Stewart Maxwell proposed that the word “decide” be used in preference to “be able to”. The Committee divided: Yes4 (Bill Aitken, Angela Constance, Nigel Don, Stewart Maxwell); No 3 (Bill Butler, Cathie Craigie, James Kelly).

¹ Scottish Government (2009), Scottish Budget – Draft Budget 2010-11. Scottish Government. Available at: www.scotland.gov.uk/Publications/2008/09/12140641/0 [Accessed 24 November 2009]

² Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2334

³ Director-General Health and Chief Executive NHS Scotland, written submission, 21 October 2009

⁴ Audit Scotland. (2008) Financial overview of the NHS in Scotland 2007/08. Audit Scotland. Available at www.audit-scotland.gov.uk/docs/health/2008/nr_081204_NHS_financial_overview.pdf [accessed 24 November 2009]

⁵ Director-General Health and Chief Executive NHS Scotland, written submission, 21 October 2009

⁶ Payne, J, and Dewar, J. (2009) Draft Budget 2010-11:Health and Sport. SPICe Briefing 09/67. Scottish Parliament. Available at: http://www.scottish.parliament.uk/business/research/briefings-09/SB09-67.pdf [accessed 24 November 2009]

⁷ Audit Scotland. (2008) Financial overview of the NHS in Scotland 2007/08. Audit Scotland. Available at www.audit-scotland.gov.uk/docs/health/2008/nr_081204_NHS_financial_overview.pdf [accessed 24 November 2009]

⁸ Appleby, J et al. (2009) How cold will it be? Prospects for NHS funding: 2011–17.The King’s Fund. Available at www.kingsfund.org.uk/research/publications/how_cold_will_it_be.html [accessed 24 November 2009]

⁹ Audit Scotland. (2008) Financial overview of the NHS in Scotland 2007/08. Audit Scotland. Available at www.audit-scotland.gov.uk/docs/health/2008/nr_081204_NHS_financial_overview.pdf [accessed 24 November 2009]

¹⁰ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2323

¹¹ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2324

¹² Director-General Health and Chief Executive NHS Scotland, written submission, 21 October 2009

¹³ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2320-1

¹⁴ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2321

¹⁵ Scottish Government (2008), Efficient Government – Efficiency Outturn Report for 2007 - 2008. Scottish Government. Available at: www.scotland.gov.uk/Publications/2008/10/Outturn2008 [Accessed 24 November 2009]

¹⁶ Director-General Health and Chief Executive NHS Scotland, written submission, 21 October 2009

¹⁷ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2326

¹⁸ Scottish Government (2008), NHSScotland Chief Executive’s Annual Report 2007/08. Scottish Government. Available at: www.scotland.gov.uk/Publications/2008/11/28081831/0 [Accessed 24 November 2009]

¹⁹ The specific HEAT targets these refer to are listed in Appendix 1.

²⁰ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2251-2

²¹ Listed in Appendix 2

²² Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2297

²³ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2297

²⁴ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2295

²⁵ Audit Scotland. (2008) Financial overview of the NHS in Scotland 2007/08. Audit Scotland. Available at www.audit-scotland.gov.uk/docs/health/2008/nr_081204_NHS_financial_overview.pdf [accessed 24 November 2009]

²⁶ Royal College of Nursing, written submission, 28 September 2009

²⁷ Director-General Health and Chief Executive NHS Scotland, written submission, 21 October 2009

²⁸ Director-General Health and Chief Executive NHS Scotland, written submission, 21 October 2009

²⁹ www.shiftingthebalance.scot.nhs.uk [Accessed 16 November 2009]

³⁰ Scottish Government (2009), Integrated Resource Framework – Q&A. Scottish Government. Available at: www.shiftingthebalance.scot.nhs.uk/downloads/1256115063-IRF%20Q%20and%20A.pdf [Accessed 16 November 2009]

³¹ Scottish Parliament Health and Sport Committee. Official Report, 7 October 2009, Col2296-7

³² Scottish Parliament Health and Sport Committee. Official Report, 7 October 2009, Col 2298

³³ Scottish Parliament Health and Sport Committee. Official Report, 7 October 2009, Col 2298-9

³⁴ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2350

³⁵ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2352

³⁶ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2335

³⁷ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2336

³⁸ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2336

³⁹ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2337

⁴⁰ Scottish Parliament Health and Sport Committee. Official Report, 28 October 2009, Col 2336

⁴¹ Scottish Government (2008), NHSScotland Chief Executive’s Annual Report 2007/08. Scottish Government. Available at: www.scotland.gov.uk/Publications/2008/11/28081831/0 [Accessed 24 November 2009]

¹ Scottish Parliament Information Centre (SPICe) Briefing on draft budget 2010-11, Table 1.

² Scottish Government Finance Directorate. Written submission to the Justice Committee.

³ The Committee notes that the re-profiling was split over two financial years.

⁴ All summary information taken from SPICe briefing. Available at: http://www.scottish.parliament.uk/business/research/briefings-09/SB09-70.pdf

⁵ Stewart Maxwell proposed that the word “decide” be used in preference to “be able to”. The Committee agreed by division: Yes 4 (Bill Aitken, Angela Constance, Nigel Don, Stewart Maxwell); No 3 (Bill Butler, Cathie Craigie, James Kelly).

⁶ Scottish Parliament Justice Committee. Official Report, 6 October 2009, Col 2266.

⁷ Scottish Parliament Justice Committee. Official Report, 6 October 2009, Col 2270.

⁸ Association of Chief Police Officers in Scotland. Written submission to the Justice Committee.

⁹ Scottish Parliament Justice Committee. Official Report, 6 October 2009, Col 2270.

¹⁰ Scottish Parliament Justice Committee. Official Report, 6 October 2009, Col 2271.

¹¹ Unison. Written submission to the Justice Committee.

¹² Scottish Parliament Justice Committee. Official Report, 27 October 2009, Col 2310.

¹³ Scottish Parliament Justice Committee. Official Report, 27 October 2009, Col 2318.

¹⁴ Scottish Parliament Justice Committee. Official Report, 27 October 2009, Col 2320.

¹⁵ Scottish Parliament Justice Committee. Official Report, 27 October 2009, Col 2303-4.

¹⁶ Scottish Parliament Justice Committee. Official Report, 27 October 2009, Col 2302.

¹⁷ Fire Brigades Union. Written submission to the Justice Committee.

¹⁸ Chief Fire Officers Association Scotland. Written submission to the Justice Committee

Contents