Every year, 500,000 bed days are lost to the NHS because of delayed discharge. The issue is one that was supposed to have been resolved almost three years ago—the cabinet secretary’s predecessor gave that commitment. I am not pretending that the problem is an easy one to solve, but there is a significant difference between the rhetoric of three years ago and the reality of today.
My concern about the integration authorities is that we have not created integration; we have created a separate, third body that is junior to the council and the NHS board in the area. When difficulty arises, those two bodies are nowhere to be seen. That is one of the challenges that we face. We have not created the integration body that we need.
The high turnover of leadership in the integration authorities is of grave concern. Seven out of the 31 authorities have had new chief officers in the past two years. There is a lack of long-term financial planning as well as a lack of data sharing. We know about the problem of the different languages that the professionals in the different halves of the organisations speak. There is a lack of collaboration between the bodies, and accountability is confused. All of that has led to 500,000 bed days being lost to the NHS every year.
The bed days figure gives an indication of the health of a hospital, because it shows the flow through the hospital. Although accident and emergency waiting times are important, the bed days figure is probably a stronger indicator of how well a hospital is performing. That is why it is so important that we get on top of the problems that we are discussing.
I will quickly give some examples of where the system is not working in Fife. There is a proposal to close the general practitioner out-of-hours facility in St Andrews, which is a responsibility of the integration authority. NHS Fife has distanced itself from the decision. Fife Council tells me that the individual councillors on the health and social care partnership are there in their own right, not on behalf of the council. If the partnership is a joint body, both the health board and the council should be responsible for its decisions, but both are distancing themselves from the proposal to close the St Andrews facility, even though the co-leader of Fife Council—I will not say which party he represents—voted for it. The whole thing is a shambles, which is why people in Fife are very confused about who is responsible for anything.
There is also turbulent leadership in Fife. Michael Kellet, the chief officer of Fife health and social care partnership, is a very good officer, but he is relatively new in the organisation. We have just lost the previous chair of the body, Simon Little—he was prematurely removed from the board. That has removed the continuity that we need. One of the wider concerns that I have raised about the performance of NHS Fife and its leadership is the fact that we have had four departures from senior positions in the body in the past two years, and I hope that the Scottish Government commissions an investigation into that.
The integration authorities have other fundamental weaknesses. There is a shortage of workers, particularly in rural areas, where workers are not paid to travel between homes to care for individuals. It is no wonder that we are finding it difficult to get carers to cover rural homes and rural patients.
Brexit, of course, is compounding the problem, which is why we need the people’s vote that Alison Johnstone talked about. Robert Kilgour has talked about the impact of Brexit in this “perfect storm”—the combination of different issues impacting on the care service.
Finally, the removal by Bield Housing & Care of 12 of its care homes is surely another indicator that the sector has serious problems.