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Displaying 3025 contributions
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
I said that the organisation is inevitably people driven. When we think about how well we are doing, we often compare ourselves to south of the border. We have additional staff and have a higher headcount than south of the border, so why are we not exponentially better?
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
NHS Highland covers greater areas at greater cost. That should not incur brokerage—it should be part of the cost of running the health board in that area, because that is never going to go away. It is part and parcel of the delivery of services. To say that geography makes a contribution to the need for brokerage does not seem valid.
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
So if boards need brokerage, that will not be caused by the fact that they have to bear the additional costs of their geographical areas.
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
I am sorry to interrupt, but when was that unit established?
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
I would like to cover various aspects of financial sustainability. NHS funding in 2023-24 grew by 2.5 per cent in real terms, but that increase mainly went on pay rises and inflation. Health is the biggest single area of Government spending. In 2023-24, it was 40 per cent of the Scottish budget. The affordability of healthcare spending was always a big issue, but it is now even more urgent and needs to be addressed. The scale and pace of reform need to increase. That was emphasised in the First Minister’s speech on Monday.
I would like to look at some different aspects of financial sustainability. One is the cost of drugs and prescriptions. The Auditor General has told us that some analysis of pay awards has been done, but nothing seems to have been done on drug costs and what drives them. As a society, we are getting older and we have longer-term illnesses and so on, but we do not know what proportion of spend drugs, for example, takes up. What is the cost and what are the projections? Do you have any information on that?
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
I will move on to another aspect. Different health boards have been under different pressures over the years, and the committee has been very much involved in looking at those situations. Eight territorial boards required brokerage in 2023-24 and some boards are forecasting recurring deficits over the next three years, which must create a risk to their financial sustainability.
Why do those recurring brokerage issues come up? Why are those boards under the pressure that they are under? It seems that Scottish Government policy is to try to do away with brokerage over a fairly short period, but that is not evidenced by what we are being told in the Auditor General’s report.
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
I move on to an issue that affects every single board, which is non-recurring costs. They seem to be embedded as an area where boards achieve a high percentage—sometimes the majority—of savings every year. That is not necessarily anything to do with brokerage; it is across the board. How far is it possible to move boards away from that? In the long term, that is not sustainable.
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
The problem is that, for years now, this committee has been seeing the reports coming in about non-recurring expenses—it is almost a core part of every board’s annual activity. How are you going to get away from that? You talk about reform and changing the health service, and the way that delivery is made and all the rest of it, but with such a significant proportion of non-recurring expenses, how are you going to balance the books? You are just playing about with numbers, really.
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
In previous reports that have come to the committee, there has been no indication of any significant improvement in non-recurring expenses. What is happening now that is going to make a difference?
Public Audit Committee
Meeting date: 29 January 2025
Colin Beattie
Eighteen months ago.