Chamber and committees

Yes, we will return to that next week and beyond. Craig Hoy has questions on one of the other topics that is important to the Parliament.

May I clarify something that probably stems from my ignorance? On the one hand, you talked, and I asked a question, about the increase in resources—an additional £4 billion over the past five or six years—but, on the other hand, the narrative in paragraph 24 of the report is about how health boards have to make savings. Can you reconcile the two for me? A record level of public money, £19 billion, is going into the national health service—not into the broader category of public health but into the national health service—yet, at the same time, there is a call on national and territorial NHS boards to make savings.

Yes, absolutely. I am sure that we will return to that point.

I will move things on and turn to something that has been of interest to the committee, not only in this but in the previous session, and that is the financial position of individual territorial health boards. In the report, you suggest that, in your assessment of the 14 territorial health boards, only three are expected to break even, which means that 11 are not. I presume that that does not mean that they will make a surplus, but that they face a financial deficit. We know that, in the past, that led you to have to produce section 22 reports about health board conduct, because concerns were raised about the routes that people chose to go down to get additional resources.

How fit for purpose are the brokerage arrangements? The term “brokerage” is about an intervention by the Scottish Government to help out individual health boards. At one point, I think, it was based on a one-year time horizon; it then went to three years. Will you bring us up to date on the current position and say whether, in your estimation, those arrangements will be robust enough to get the health boards through the challenges that they face?

Thank you very much indeed. Without further ado, I invite the deputy convener, Sharon Dowey, to open the questioning.

Good morning. I welcome everyone to the 10th meeting of the Public Audit Committee in 2023.

The first item for committee members to consider is whether to take agenda items 3, 4 and 5 in private. Are we agreed to take those items in private?

Members indicated agreement.

The main agenda item is consideration of the Auditor General for Scotland’s report on the national health service in Scotland in 2022. It was released exactly one month ago today. We are pleased to welcome the Auditor General for Scotland, Stephen Boyle, to give evidence on that report. He is joined by executive director, Antony Clark; senior manager, Leigh Johnston; and senior auditor, Fiona Lees; all from Audit Scotland. You are all very welcome.

We have a large number of questions to put to you on what was an impactful report. Before we ask those questions, the Auditor General will make a short opening statement.

My take from that is that we cannot rely on a top-down solution; there needs to be proper participatory engagement of people if there is going to be any faith placed in any reforms that happen.

Thank you so much for your evidence. As I said at the start, the report was impactful when it was published and I think that it will continue to resonate. It has certainly given us, as a committee, quite a number of areas that we will want to pursue to get to where we think public interest needs to get to on where these reforms are; what is happening with the money that is going into the NHS; whether the outcomes are being delivered; and, if they are not, why not and what can be done to fix that. Thank you very much for your contributions this morning, and I thank committee members for their questions.

Presumably, you will also keep an eye on how that fits in with net zero targets and that whole agenda of how the public sector estate needs to be changed quite substantially to meet our ambitious goals for reducing carbon emissions.

That is very helpful. I will develop that theme a little bit. There is the question of innovation. It comes back to the fact that it is not just about the money but about how we do things. You cite in the report a couple of examples of innovation. One of those—the NHS 24 system—is a bit more long-standing and structural. It has been reviewed and reformed.

There is a case study in the report about the Scottish Ambulance Service intervention. I think that you said that it has established an integrated clinical hub to introduce a level of clinical judgment to determine whether, where there are calls for ambulances to attend, a reasonable demand is being placed on the service. The finding that the Scottish Ambulance Service supplied to you was that, when interventions were made, it was discovered that up to 50 per cent of the calls did not require a 999 ambulance. That result is based on intervention in 15 per cent of calls. Will you reflect on that? If there were a greater level of intervention so that more calls were screened or had that clinical judgment applied to them, would that lead to the same kinds of results right across the entire service?

Okay. Obviously, we are talking about people, but, from an audit point of view, the unit cost to the health service of agency staff is considerably more than the cost of a direct employee, is it not?