Chamber and committees

Cabinet secretary, I want to check something with you before we move on. The Deputy First Minister is leading on the budget. When it is published, will it include a breakdown of preventative spend? Will it be clear what constitutes existing preventative spend? For example, you could argue that funding for family nurse partnerships, free school meals and free prescriptions is all preventative spend—and those are just some of the things that Government is already funding.

When you look at recurring budget lines, you can see that they represent preventative spend. However, that does not take us any further, because the money is already in the system; it is not new. When the budget is published, will it be clear where the new money for preventative spend is flowing through the system?

10:15

You can correct me if I am wrong, but I think that you are saying that the target is based on non-front-line staff who are involved in non-front-line services, and what you think is the art of the possible in general terms, rather than any specific sector. Is that the case?

I think that that would be helpful.

Percentage terms are important, but these are real jobs that exist currently. What are the whole-time equivalent numbers or workforce numbers in raw terms for posts that will ultimately go or be reformed or restructured?

I am going to come back in again—

Has modelling work been done in relation to those reductions in the NHS?

I anticipated that that would be the response. Driving as fast as possible and realising the benefits as speedily as possible is absolutely your role here, cabinet secretary. I thought that that was an important question to ask for context.

Agenda item 2 is an evidence-taking session on delivering public service reform. I welcome to the meeting Ivan McKee, Cabinet Secretary for Public Service Reform, who is accompanied today by three Scottish Government officials: Gabrielle Cahen, team leader, public service reform strategy and evidence; Ruth Meyer, head, public service reform strategy and governance unit; and Simon Mair, deputy director, place-based service change and reform. I thank you all for supporting our scrutiny this morning.

Cabinet secretary, we look forward to working constructively with you on public service reform and to being a critical friend to you. We will challenge, where appropriate, but constructiveness will be our aim as a committee as we move forward.

I understand that you have some opening remarks to make to the committee.

Good morning again, everyone. We now move back into public session for agenda item 4, which is an evidence session on delivering public service reform.

I welcome to the meeting Stephen Boyd, director of the Institute for Public Policy Research Scotland; Stephen Boyle, Auditor General for Scotland; and Dr Claire MacRae, senior lecturer in public policy at the University of Glasgow. I thank all three of you for supporting our scrutiny work here this morning. If anyone wishes to make some opening remarks, they are more than welcome to do so.

That is helpful as a scene setter. The word “scale” has come up consistently. The scale of the fire service and Police Scotland reform aside—perhaps Scotland’s colleges would be another example—scalability has been a challenge and, if it takes place, moving from 14 health boards to two health boards is quite a significant reform. It also sits alongside Stephen Boyle’s report on the state of the NHS, about headline policy aspirations not always matching delivery on the ground.

Mr Boyle, I think that it was in your December 2025 report that you said that there was poor evidence of a shift from acute into community care and treatment. The programme for government included increasing the number of hospital at home beds to 10,000, but at the same time, the NHS will have to move from 14 to two health boards. Is it possible to do the organisational structural change, which is bureaucratic in some respects—changing from 14 to two health boards—at the same time as doing the on-the-ground work that needs to be done to shift moneys and reform from acute into community care? Do you have any confidence that that can be done? What are the challenges around that?

That is helpful. Before I bring in other witnesses, I will just roll in one final question, because I want to bring colleagues in on this as well. In terms of measuring outcomes, what does success look like?

Committees might want to consider what a successful outcome might look like. If we take health as an example, one measure of success might be an organisation having 8 per cent fewer senior managers and saving £X million. However, from their perspective, communities might consider success to be community-based and preventative interventions that are delivered locally and are attentive to their needs. We therefore need clarity from the Government on how both those outcomes will be measured. One should not take priority over the other. In particular, the outcomes in relation to financial savings and organisational sustainability should not take precedence over the kind of healthcare system that we want.

11:45

What outcomes would you like to be measured as the reforms progress? This committee will be keen to ask those questions not only in relation to the NHS, but in relation to local government, environmental services and wherever else reforms are under way. What outcomes of community benefit should we be measuring?