Seòmar agus comataidhean

I also want to understand how you use the data that is being collected to drive improvements. Can you point to any examples of where you have said, “We’ve seen this problem arise, this is how we have addressed it, this is how the service has now improved to deliver better support”? We have had a lot of feedback about the approach being reactive and risk-based rather than focused on good outcomes for a person’s wellbeing.

There was a suggestion that annualised budgets are a way forward in respect of improving provision and providing the extra capability, scope and agency for individuals to direct their own care. I throw that in as one example that I have heard in recent discussions with stakeholders. Can you point to any other examples where you have identified opportunities for improvement and are looking to make improvements but maybe not been done so yet?

Are you looking specifically at improving the pooling and annualising of budgets? Is that workstream being taken forward in those forums?

[Inaudible.]—previous line of questioning, but I want to ask how clearly the culture of self-directed support is embedded across staff and what formal training and programmes are in place to inform staff about the full range of the options available? Is there a formalised process of continuous professional development courses such that staff have protected time available to undertake training to understand the latest developments in self-directed support and how to improve the services?

We talked about senior social workers discussing continuous improvement. Does that also take place at a lower level within health and social care partnerships? Any insights there would be useful.

I appreciate that; thank you.

Would the cancers that are being diagnosed at A and E ones typically be diagnosed through screening?

Thank you to the witnesses for their contributions so far. We are looking at the factors that contribute to longer waits for diagnostic tests, which certainly chimes with what we heard from oncologists, who said that it is agonising for them to watch patients go from diagnosis to a terminal situation.

What factors are contributing to that, what progress has been made to ensure that rapid cancer diagnosis is available across Scotland, and what more needs to be done?

On the impact of funding on future service design, local authorities have, on average, had a 10 per cent cut over the past decade. Around 80 per cent of local authority funding is central Government grant and 20 per cent is raised through council tax and local charges. In Glasgow, the percentage of funding that is spent on education and social care has risen from 60-odd per cent to over 70 per cent. Clearly, the council’s focus has been pared down to two big areas of policy delivery, which puts subsequent pressure on delivery.

How do we break the cycle of annual budgets that are under increasing pressure, which is being ratcheted up, for health and social care partnerships and integration joint boards, which we then see being backed up into the NHS? I am trying to figure out how we break this prison of accountancy, if you like, and build the case for cost avoidance. We just heard about people presenting at A and E departments with late-stage cancer. Those are obvious business cases that show that, if we deal with something earlier, we will avoid a lot of costs to the public in the longer term and have better outcomes for people. What are your insights into how we better design that model for the future?

Some of the organisations that run screening programmes for the NHS have said that invitations to present for screening can vary widely across different social and demographic areas. For example, there is a difference between getting a letter and getting a text message. Have you seen differences in how people react to different types of screening invitation?

That certainly chimes with an experience that I had visiting a Marie Curie hospice in Glasgow, where I met a lady with throat cancer. She lived in Bridgeton, in the east end of Glasgow, and she expressed her devastation that, on presenting to her GP, she was fobbed off repeatedly. By the time she got a diagnosis, it was terminal, and she was only in her early 40s. That was quite harrowing. She died the day after my visit.

What practical steps can we take to address that? Is it an attitudinal or cultural issue? Is it a practical thing? Is there a means of better escalation for patients who feel that they are not being listened to? Is it purely about patient agency? What other aspects could we consider?

Is the issue then not just about the structure of GPs as individual contractors, if you like, and their obligations to undertake data gathering and so on, but also about the work that is currently being done to understand where late-stage referrals are happening and whether they correlate to areas of high deprivation, and to then investigate the cause of that late presentation—whether it was frustration with access or simply that the person had not presented until a late stage? Is there any data around that at the moment that will give us an insight?