Chamber and committees

Convener, I thank you and the committee for your forbearance and allowing me time to ask questions, and I thank the Auditor General for what is, I hope, a very useful report. You have highlighted, rightly, that there have already been an awful lot of reports from various sources.

To start with, I want to follow on from Colin Beattie and ask about delayed discharge. You have said that things are taking too long and that there is no clear plan in place. Ryan Caswell, a constituent of mine, has been a delayed-discharge patient for five years and 10 months in completely inappropriate settings. I have raised his case again and again and again and again, but there seems to be no progress in getting him out of that inappropriate setting and into another situation.

My question, then, is this: is the structure limiting progress? You have touched a little bit on the interaction between the health board and the IJBs. In the research that you have done and the work you have looked at, is the relationship between the IJBs and the health board just too intractable to deliver an outcome and make the change?

On 2 May, I asked the board when it will next examine the business case and associated costings for the move, and it has still not provided any indication of when it will do so. Has Rachel Browne or Eva Thomas-Tudo seen in their work any evidence that the board has looked at a revised plan setting out the costings for, and the impact of, such a move?

I suppose that what I am asking—

You started the evidence session by talking about the issue of leadership, Auditor General, and the comment in the report about NHS Tayside having

“Limited skills and capacity for leading and participating in the”

whole-system change programme really jumps out. You have said that the board is trying to bring in a single member of staff to do that work, but can you say more about where that capacity and that capability are missing? Is it in the IJBs, or is it in the central leadership? What is the deficit that the board is trying to make up?

Okay. Surely, given this changing environment, with different leadership over different periods of time, we should not be losing sight of those recommendations. They came out in 2020, and the progress report, which came back in 2021, has been described to me as

“the worst report in Scottish public life”.

As the convener has pointed out, it showed local bodies in Dundee misleading the public about progress that had not been made. We had the oversight assurance group in 2021, which reported in 2023, and now we have the whole system change programme.

All of that leads me to ask this question: do we not need external leadership to actually deliver this? The current model of leadership is just not working, is it?

Is anybody reporting to the board on progress against those 51 recommendations in the report that was brought out? A lot of work went into that analysis. Are those things being reported on? I have to say that I cannot see any evidence that they are. They are being substituted by one programme after another, instead of someone saying, “This is the mission. We need to deliver it. How do we get there?” After all, we are now six years on.

I want to stick with the issue of scope for a moment. Will the current scope of the whole system change programme meet the 51 recommendations of the Strang review?

Moving on to single site provision, I would note, as an example, the state of Strathmartine hospital, which the Mental Welfare Commission for Scotland reported on in 2018, 2019, 2020, 2021, 2023 and 2024. The 2024 report on the hospital, which set out what I have described as “Dickensian conditions”, was published only half an hour before I had a meeting with the chair and the chief executive of the Mental Welfare Commission. It was months late; it would not have been published, had I not asked for a meeting. You talk about oversight and accountability—these are the reports that the leadership should have been responding to, but were not.

You have said that changes have been made to the physical environment. I agree with that—I have been to the site, and I have seen those changes—but what really concerns me is your comment that there is no clear plan and no costings for the move to single site provision. Do you think that that information has to be provided and put into the public domain by the board, for the sake of accountability?

Is your understanding of that live—in other words, as of today? I have to say that I have a very different understanding of the completion of the one-to-ones. Staff were told that the process was to be completed by August, but then at the end of June—four weeks before the process was meant to be completed—they were told that it would not be happening. I had been telling the health board for many months that there was no chance of it happening in August—that was absolutely clear.

There has been no publication of the capital costs or the investment in Murray royal hospital that is required; nothing about the overtime required to transfer staff from one place to another; nothing about meeting with bank staff; and nothing about the shortfall. Have you seen plans that actually contain that detail? Has the board examined the cost of making this move versus the need to deliver for patients?

When was that?