Chamber and committees

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?

Thanks. Another area mentioned in your report is NHS 24 interventions. By the same token, how effective have they been? Is NHS 24 revising the way that it works? Is more investment going into it, particularly given the Covid-experienced environment that we are now in? The delivery of public services is viewed slightly differently, is it not, in light of what had to happen over the course of the pandemic? Can you enlighten us on the NHS 24 changes or interventions and how effective they have been?

That is fine. We will, I am sure, return to those issues in subsequent sessions on the NHS.

The NHS is a very high priority for all of us in the Parliament and I reflect that the terms of our debate about it often contrast inputs and outcomes. Your report notes that there has been a £4.4 billion increase in NHS spending since 2018-19 and that the budget for 2023-24 is estimated to be over £19 billion. You assessed that level of expenditure as being three years earlier than anticipated. There is no question that there is substantial public investment going into the NHS, yet we do not necessarily see outcomes improving. The rather fundamental question is, do we just need funding or is it necessary to apply other factors in order to rise to the challenges that we are facing in the national health service?

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, thanks. The broader questions, which we have touched on before, are around inequality and poverty, which are often the drivers of the demands that are placed on the national health service. So, there is a broader public health question and a societal question. We probably do not have time to go into that this morning, but it is an important thread that runs through the issue.

I will apply the handbrake and jump on to something else, which is related but quite different. In the report, you talk about the capital maintenance backlog budget. I know that it has been the focus of attention in previous years. Again, there is a long-standing critique of why it should be backlog maintenance rather than proactive maintenance. If maintenance is carried out on an on-going basis, it becomes less reactive and probably more cost effective. Again, that might be another debate for us to have.

In the report, you indicate that it is proposed to double investment in the capital maintenance backlog budget over the next five years. Given all the other pressures on spending in the national health service, how confident are you that that is an achievable goal?

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.

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.