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Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
I have a quick follow-up question that is based on the Audit Scotland report. You said that you agree with its findings and recommendations. One of the headline findings of the report is:
“The proposed National Care Service will place a huge strain on the health and social care budget”.
Do you accept that conclusion?
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
Okay. Thank you. We will watch that with interest.
You used the word “challenging” a few times. It is worth noting, for the record, that the word used by the Auditor General is “concerning”. In paragraph 17 of the report, he said:
“The financial position of the NHS in Scotland is concerning.”
There is, I think, a suggestion there that things are not as they should be and that there are potential consequences for the kind of treatment that people can expect to get.
I will turn to what is, I suppose, at the heart of many of the questions that we are asking you this morning. How long does the Scottish Government think that it will take to clear the current backlog and fully recover healthcare services to a pre-pandemic level?
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
I am sorry to labour the point, but what is the budget, for example, for the Larbert site? What is the budget for the NHS Golden Jubilee site? Where do they now sit?
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
That pretty much brings us to the close of the session. There are two things in the report that I want to highlight, on which I would welcome your views. One is the agenda for reform. The clear message from the Auditor General is that the level of funding for the NHS is at a record level—£19 billion—yet we continue to see suboptimal outcomes. I guess that the debate about what we need to do to change and reconfigure services is central to that.
Some of this goes back to the Christie commission of over 10 years ago and what it said about having a preventative agenda and taking a broader view of public health, rather than just having a view of the institution of the national health service. That rests on public debate and engagement, so, in closing, it would be useful to find out your perspective on that and what your plans are in that regard.
The other issue is related to that. One of the key recommendations in the report—you said that you accepted the recommendations—was that you publish annual progress updates on service reform. Is it your intention to do that?
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
Mr Burns, you are using the language of progress and improvement but, to give two examples from the Audit Scotland report, the percentage of A and E attendances seen within four hours dropped from 83 per cent in December 2019 to just 62 per cent in December 2022, and paragraph 37 of the report states that delayed discharges
“increased to the highest level since 2014/15”.
That does not sound like progress and improvement to me. It sounds as if we are going not forwards but backwards.
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
The financial memorandum has been questioned by the Auditor General, and it was also questioned pretty heavily by the Finance and Public Administration Committee, which told you that you needed to go back and do your sums again and come back with a revised financial memorandum. I cannot remember a time when it was necessary for a Government department to revise its financial memorandum because it was seen to be so out of sync with what people estimated the costs would be. Do you feel embarrassed about that?
09:30Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
I presume, however, that you agree with the recommendation in the report that the Scottish Government and NHS boards need to work “more collaboratively” in the future.
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
You accept, though, that there has been a delay.
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
This next question might be for Caroline Lamb. One of the criticisms, or part of the analysis, in the Audit Scotland report is that one of the flaws in the NHS recovery plan, which was launched in August 2021, was that it did not come as a result of proper consultation with the territorial health boards. There was a commitment—perhaps a political commitment—that, within 100 days of the election in 2021, the NHS recovery plan would be published, but the consequence of that, according to the analysis in the Audit Scotland report, is that the health boards were not involved. Is that a matter of regret for you?
Public Audit Committee
Meeting date: 4 May 2023
Richard Leonard
I will bring in Craig Hoy in a second. We have spoken about the number of GPs, and about recruitment and retention and so on. Last year, the committee was quite exercised by the broader picture of GP data, which we took up with you in correspondence. I can characterise it as follows: on the one hand, we have GPs saying, “We’re seeing more patients than ever”, and, on the other hand, our postbags are full of correspondence from people saying, “I can’t get an appointment with a GP.” We were quite keen to have transparency on that. We certainly corresponded about an oversight group that you had put together that was, I think, an attempt to get into the granular detail. Can you update us on that work?